GF PD 001

ROUND 10
PROPOSAL FORM – ROUND 10

SWAZILAND
SECTIONS 1-2
Applicant Name SWAZILAND CCM
Country SWAZILAND
Income Level LOWER MIDDLE INCOME

 Refer to Annex 1 in the Round 10 Guidelines
Applicant Type CCM Sub-CCM Non-CCM
If your country is also part of a Round 10

multi-country proposal, indicate for which HIV
disease(s)
Currency USD Euro
Does the proposal Is this being

include cross-cutting submitted as a
health systems consolidated
Disease Title strengthening disease
interventions? proposal?
 Indicate yes or no and
Include sections 4B and 5B  Indicate yes or
in one proposal only no
Regular
Strengthening community
HIV systems and linkages in No No
Swaziland.
Expand access to high quality

DOTS; Address TB/HIV co-
Yes
Tuberculosis infections and emergency No
response to the challenge of
MDR-TB
Malaria
R10_CCM_SWZ_HT_PF_s1-2_27Sep10_En 1/15
ROUND 10
SECTION 1: FUNDING SUMMARY AND CONTACT DETAILS
Clarified section 1.1
1.1 Funding summary
Round 10 Funding Request

Disease
Year 1 Year 2 Year 3 Year 4 Year 5 Total
HIV
$17,789,523 $16,934,070 $17,501,110 $18,504,838 $18,879,763 $89,609,304
Tuberculosi $10,489,404.8 $10,547,100.9

$7,702,629.11 $9,268,906.03 $9,704,613.51 47,712,654.48
s 8 5
Malaria
Cross-
cutting HSS
interventio
ns
 Insert
disease name
$137,321,
Total Round 10 Funding Request
958.48
1.2 Contact details
Primary contact Secondary contact
Name Mr. Mbuso C. Dlamini Mr. Vulindlela Msibi
Title CCM Chairperson CCM Executive Secretary
Organisation CCM CCM
Mailing address PO Box 395 Mbabane, Swaziland PO Box 178, Mbabane, Swaziland
Landline: +268 404 2251 Landline: +268 404 1703/8
Telephone
Mobile: +268 7606 2710 Mobile: +268 7602 5594
Fax +268 404 7300 +268 404 7300
E-mail addresses dlaminimb@gov.sz vdmsibi@swazi.net
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1.3 List of Abbreviations and Acronyms used by the Applicant
Acronym/
Definition
Abbreviation
ACF Action Contre la Faim (Action Against Hunger)
AIDS Acquired Immuno Deficiency Syndrome
ANC Antenatal Care
ART Anti Retroviral Therapy
ARV Anti Retroviral
BCC Behaviour Change Communication
BOP Budget Outlook Paper
BSS Behavioural Surveillance Survey
CANGO Coordinating Assembly of Non Governmental Organisations
CBO Community Based Organisation
CCM Country Coordinating Mechanism
CHAI Clinton Health Access Initiative
CHH Child Headed Household
CHIMSHACC Chiefdom Multi-Sectoral HIV and AIDS Coordinating Committee
CMS Central Medical Stores
COSPE Cooperazione Per Lo Sviluppo Dei Paesi Emergenti
CSO Civil Society Organisation
CSS Community Systems Strengthening
DOTS Directly Observed Treatment Short-Course
DPM Deputy Prime Minister
DQA Data Quality Audit
DSW Department of Social Welfare
ECCD Early Childhood Care Development
EGPAF Elizabeth Glaser Paediatric AIDS Founding
EmONC Emergency Obstetric Care
EU European Union
FBF Fortified Blended Foods
FBO Faith Based Organisation
GBV Gender Based Violence
GIS Geographic Information System
HACCP Hazard Analysis Critical Control Point
HDI Human Development Index
HIV Human Immuno Virus
HSS Healthy Systems Strengthening
HTC HIV Testing and Counselling (Initiated by the health care provider)
ICAP International Development Association
IEC Information Education Communication
IMAM Integrated Management of Acute Malnutrition
IPT Isoniazid Preventive Therapy
M&E Monitoring and Evaluation
MARPS Most At Risk Populations
MCHN Mother Child Health Nutrition
MCP Multiple Concurrent Partners
MDG Millennium Development Goals
MDR Multi Drug Resistance
MESST Monitoring and Evaluation System Strengthening
MHT Municipality Health Team (equivalent to the CHIMSACCs, but in urban centres)
MIS Management Information Systems
MNCH Maternal, Newborn and Child Health
MoET Ministry of Education and Training
MoH Ministry of Health
MOT Modes of Transmission
MoPSI Ministry of Public Service and Information
MSF Médecins Sans Frontier
ROUND 10
MTAD Ministry of Tinkhundla and Administration
MTCT Mother To Child Transmission
MTEF Medium Term Expenditure Framework
NAP National Action Plan
NASA National AIDS Spending Assessment
NATICC Nhlangano AIDS Training Information and Counselling Centre
NCC National Coordination Committee
NCCU National Children’s Coordination Unit
NCP Neighbourhood Care Point
NDS National Development Strategy
NEPAD New Partnership for Africa’s Development
NERCHA National Emergency Response to HIV and AIDS
NGO Non Governmental Organisation
NRL National Reference Laboratory
NSF National Strategic Framework
NTP National TB Programme
ODL Open Distance Learning
OI Opportunistic Infection
OVC Orphaned and Vulnerable Children
PDT Proposal Development Team
PEP Post Exposure Prophylaxis
PEPFAR Presidents Emergency Programme for AIDS Relief
PLHIV People Living with HIV
PMTCT Prevention of Mother To Child Transmission
PR Principal Recipient
PRSAP Poverty Reduction Strategy and Action Plan
PSHACC Public Sector HIV/AIDS Coordinating Committee
PSI Population Services International
PSS Psycho Social Support
QIMS Quality of Impact Mitigation Services
REMSHACC Regional Multi – Sectoral HIV and AIDS Committee
RHM Rural Health Motivators
RUTF Ready to Use Therapeutic Food
SADC Southern African Development Community
SAM Service Availability Mapping
SDA Service Delivery Area
SDHS Swaziland Demographic Health Survey
SHAPMoS Swaziland HIV&AIDS Planning and Programme Monitoring System
SNAP Swaziland National AIDS Programme
SR Sub Recipient
SRH Sexual Reproductive Health
SSR Sub Sub Recipient
STI Sexually Transmitted Infection
SWABCHA Swaziland Business Coalition on HIV/AIDS
SWAGAA Swaziland Action Group Against Abuse
SWANNEPHA Swaziland National Network of People Living with HIV and AIDS
SWAPOL Swaziland Positive for Life
TB Tuberculosis
THP Traditional Health Practitioners
TIMSHACC Tinkhundla Multi – Sectoral HIV and AIDS Committee
TWG Technical Working Group
UKZN University of Kwazulu Natal
UNESCO United Nations Education, Scientific and Cultural Organisation
UNICEF United Nations Children’s Fund
UNISWA University of Swaziland
URC University Research Council
VAC Vulnerability Assessment Committee
WFP World Food Programme
WHO World Health Organisation
WLSA Women and Law in Southern Africa
XDR Extensive Drug Resistance
ROUND 10
SECTION 2: APPLICANT SUMMARY AND ELIGIBILITY
CCM applicants
 Complete sections 2.1 & 2.2
 Delete sections 2.3 & 2.4
2.1 Members and operations

Clarified section 2.1.1
2.1.1 Membership summary  tick the relevant box
Sector Representation Number of members
Academic/educational sector 1
Government 8
Non-government organisations (NGOs)/community-based

2
organisations
People living with the diseases 1
People representing key populations 0
Private sector 1
Faith-based organisations 1
Multilateral and bilateral development partners in country 2
Other 0
Total Number of Members: 16

 Must equal the number of members in the Membership Details form1
ROUND 10
Clarified section 2.1.2b
2.1.2 Broad and inclusive membership
Since your last eligible application to the Global Fund:
(a) Have there been any changes in members since the Yes
last time the CCM (or Sub-CCM) was determined No  go to section
eligible? 2.1.2 (b)
(b) If ‘Yes’ in part (a), describe in the space below how those new members were selected.
The last eligible application was in 2008 during Round 8. In 2009 the Swaziland CCM reviewed its by-
laws based on Global Fund requirements and practices taking into account country requirements. The
reviewed by-laws categorize the CCM Members into substantive, alternate and ex-officio members. The
present substantive members are seventeen.
The government of Swaziland is represented by five government ministries, namely, Prime Minister’s
Office, Ministry of Health, Ministry of Tinkhundla Administration and Development, Ministry of
Economic Planning and Development, Ministry of Urban Development; and three sub-entities namely
NERCHA Council, National TB program and National Malaria Program.
The former Chairperson from Government; Ministry of Health retired and the CCM elected the Principal
Secretary from the Prime Minister’s Office who was Ms Nomathemba Hlophe. She was transferred to
another Ministry and the CCM elected the present CCM Chairperson also from the Prime Minister’s
Office who is Mr. Mbuso Dlamini.
The former Vice Chairperson (Mr. Rudolph Maziya) representing civil society was previously wrongly
listed as Government but the Vice Chair position has always been a civil society representative. The
previous holder of the vice chair position (Ms Doo Aphane) resigned in 2010. Following this the Civil
Society network CANGO, met and democratically elected Rev. Senzo Hlatshwayo as their new
representative to the CCM.
The WHO currently is an alternate member; with the substantive member being UNICEF. The members
of the in-country United Nation system met and elected Dr. Jama Gulaid of UNICEF. The current
membership of the CCM stands at sixteen (16).
(c) Is there continuing active membership of people living

Yes
with and/or affected by the diseases?
(d) Is there continuing active membership of males and

females and/or any improvement toward gender Yes
balance among members?
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2.1.3 Member knowledge and experience in cross-cutting issues
(a) Health Systems Strengthening: Describe the capacity and experience of the CCM (or Sub-CCM) on
health systems strengthening issues
The CCM membership is composed of professionals and experts in the area of health (including public
health), who have vast experience in the management of health systems both in Swaziland and in other
SADC countries. The members of the CCM comprise of medical doctors such as the Principal Secretary
of the Ministry of Health, the WHO Representative, the UNICEF Representative and the National ART
Coordinator. In addition, there are health professionals such as the Malaria Programme Manager,
HIV/AIDS Programme Manager and the TB Programme Manager. Some of these professionals, including
the Deputy Director of Health Services are public health specialists, who have experience in working in
the country.
The CCM has recognized that the three diseases HIV, TB and Malaria cannot be managed effectively if
the cross cutting issue of health systems is not dealt with. It is for this reason that the above members
of the CCM decided to apply for the HSS grant in Global Fund Round 8, which was awarded and is being
implemented. The decision was based on the recognition that a health sector response to all the 3
diseases requires similar health system improvements in order to have the desired impact. The
programme managers of the three diseases, including the ART programme, have worked together in the
development of a system for transporting laboratory samples, which will soon become operational in
the country. The UN agencies and PEPFAR, who are represented in the CCM, have been working with
the Ministry of Health in the improvement of health systems in the country. Some of these areas
include the leadership of WHO in the development of the Essential Health Care Package and PEPFAR
supporting activities around developing leadership skills for human resources for health.
(b) Gender: Describe the capacity and experience of the CCM (or Sub-CCM) in gender and also issues
concerning sexual orientation and gender identities.
 Expertise and skills in methodologies to assess gender differentials in disease burdens and their
consequences (including differences between men and women, boys and girls), and in access to
and the utilization of prevention, treatment, care and support programs; and
 Comprehensive knowledge of the factors that make women and girls and sexual minorities
vulnerable such as harmful gender norms, behavior, attitudes and practices that underlie the
differentials in the spread of HIV (e.g. gender based violence, discrimination and stigma, sexual
female mutilation, early marriage, masculinity, etc).
The Swaziland CCM includes a wide range of stakeholders, including affected populations, government
and civil society organisations that focus on the increased risk of women and children. A number of
members have direct experience in developing programmes and service delivery focused on the
specific needs and vulnerabilities of women and young people who bear the burden of the disease in
Swaziland; (e.g., UNICEF, WHO, women’s rights organisation’s from civil society) Additionally members
have capacity and experience in mobilising and strengthening community-based groups to be in a
better position to influence health systems and service providers making these more relevant to the
needs of women, girls, men and boys.
Members have played a pivotal role in shaping the human and women rights agenda in Swaziland,
occupying leadership positions in their organisations. These organisations include the following civil
society organisations: Lutheran Services Development (focusing on women rights for rural women),
World Vision (focusing on children’s rights), Women and Law in Southern Africa (carrying out research
on Women inheritance, access to land and etc], They have actively participated in national structures
and initiatives such as the Constitutional Review.
ROUND 10
At CCM meetings the human rights and the gender agenda is increasingly visible. The NSF embraces the
principles of human rights based approach and as well as gender equality and equity. The Swaziland
CCM is also supporting the lesbian gay bisexual and trans-gender as a Round 10 multi-country proposal.
(c) How many members of the CCM (or Sub-CCM)
have considerable expertise in one or both of the 3
areas described in section 2.1.3 (b)?
(d) Multi-sectoral planning: Describe the capacity and experience of the CCM (or Sub-CCM) in multi-
sectoral program design.
The CCM embraces multi- sectoral planning approach, and is supported in this by its multi – faceted
membership. There is currently a multi-sectoral approach within the country, driven by the
government through the National Emergency Response Council on HIV and AIDS (NERCHA) and
supported by the key national bodies leading the national AIDS, TB and Malaria programmes; this
approach has led, for example, to the development of the National Strategic Multi-sectoral Framework
for HIV/AIDS 2009-2014 (NSF) which the majority of members of the CCM were involved in. The process
of developing the NSF was participatory and involved stakeholders from communities, civil society,
People Living With HIV (PLHIV), Traditional Health Practitioners (THP), private sector, Government
institutions and development partners (including United Nation Agencies, European Union and US
Government and other donors). The CCM stakeholders were involved through technical working groups,
regional consultations and programme consultations.
The chair of the CCM is the Principal Secretary of the Prime Minister’s Office, and so has multi-sectoral
functions. Additionally the CCM members who represent UN Agencies, particularly UNICEF, UNAIDS and
WHO, also have extensive experience with multi-sectoral planning and programme design.
ROUND 10
2.2 Eligibility
2.2.1 Application history
Recently applied for funding in Round 8, or Round 9, or RCC  Complete sections 2.2.2 to 2.2.8
Waves 5-8 and was determined eligible

2.2.2 Proposal development process
(a) Describe the process used to invite submissions for possible integration into the proposal from a
broad range of stakeholders including civil society and the private sector, at the national, sub-
national and community levels, as well as from key populations, where applicable.
 Explain the process for each disease proposal in the application
Following the CCM decision to submit an HIV proposal in Round 10, the CCM appointed a Proposal
Development Team (PDT) to drive the proposal development process, and to ensure regular input from
all sectors. The PDT represented a broad range of stakeholders (government, civil society, multilaterals
& bi-laterals). The PDT then developed concept papers for the two areas: HIV and TB, which were
presented to the CCM and approved.
HIV
Information about the concept note and an invitation to a National Validation Meeting to gain input to
the concept note was disseminated throughout the whole of Swaziland using emails, radio, TV and print
media. The meeting on 28.05.10 was well attended by 120 participants from all sectors and
modifications were made to the concept paper.
Next organisations were invited through a public advert run in the local print media, radio and TV to
submit Expressions of Interest to form the country proposal to the Global Fund. The CCM received a
total of 130 expressions of interest, again showing representation from all sectors – government, civil
society (including international and local NGOs, CBOs, People Living with HIV (PLHIV)), Faith Based
Organisations (FBOs), traditional and community institutions as well as the private sector.
A meeting was then held with all of these stakeholders who had submitted expressions of interest to
share information on the analysis of the submissions with a view to determining the way forward
regarding the whole process of the proposal development. The meeting resolved to form eight clusters,
reducing the 130 expressions of interest to eight proposals; encouraging the applicants to find relevant
cluster or sector. The clusters were as follows: Government, FBOs, PLHIV, Urban response, NGOs,
Traditional and community institutions, private sector and the media. These cluster proposals were
then consolidated and rationalised to ensure focus on the objectives and SDAs and to avoid repetition,
and form the basis of the proposal submitted, ensuring a clear focus on stakeholder needs.
TB
Additional to the CCM initiative, the National Tuberculosis Control Programme in collaboration with the
Swaziland Stop TB Partnership convened a stakeholders meeting to discuss the round 10 proposal
development on 10th June 2010. During the stakeholders meeting, the current TB situation as well as
the programmatic and financial gaps and the relevant priority interventions for which additional
funding is to be sought from the Global Fund were discussed. Stakeholders were also orientated on the
Global Fund process and how to apply for the round 10 TB grant. Specifically, orientation was given on
the new grant architecture, the new guidelines on technical assistance, issues of equity, cost-
effectiveness and community systems strengthening. The meeting concluded with the development of
a road map for the proposal development process. This included the two week time period set for the
submission of proposals by all interested stakeholders and other follow up meetings for integration of
these submissions.
ROUND 10
Following the stakeholders meeting, proposals were received from 10 organizations as follows: 1) The
Swaziland Stop TB Partnership as umbrella body for overall coordination of TB/HIV stakeholders (NGOs
and CBOs) operating in Swaziland; 2) Medicines Sans Frontiers (MSF) to improve access to TB/HIV care
and increase number of patients enrolled on TB treatment and ART through decentralization of care in
all primary Health Care (PHC) facilities in Shiselweni Region; 3)Swaziland Association for Positive Living
for Life (SWAPOL) to implement TB and HIV stigma reduction awareness activities and patient literacy;
4) Good Shepherd Hospital proposed for the development of locally led, sustainable, integrated health
system delivery of high-quality TB care and management across the Lubombo region; 5) University
Research Corporation (URC) to improve management of childhood tuberculosis, increase TB case
enrollement and treatment success rate by strengthening DOTS, decentralization of TB and HIV testing
and MDR-TB in PHC clinics and community level; 6) Muna Health Life Institute – to promote National
Healthlife consciousness for TB prevention, treatment adherence and coping strategies; 7) Swaziland
Church Forum : to train Church leaders on TB towards raising awareness by the church on TB; 8)
Expression on interest from Traditional Health Practitioners to be trained on how to suspect and refer
TB suspects and provide community-based DOT; 9) Phumulela Clinic: to enhance awareness about TB
among the communities of Lobamba Lomdzala and environs. Futhermore consultations were also held
with the National Health promotion unit in the Ministry of Health on strengthening the health
promotion units at national and regional levels to support the Advocacy, Communication and Social
mobilization activities for TB control. The proposals received from these stakeholders were then
integrated into the TB round 10 proposal.
Finally the consultations with stakeholders also included a session on the Global Fund Round 10 process
at a National Gender Consultative Workshop on Universal Access for Women & Girls, and a number of
outputs from the action plans drawn up at this workshop have been included in the Round 10 country
proposals.
ROUND 10
(b) Describe the process used to transparently review the submissions received for possible
integration into the proposal.
HIV Process
To ensure that the review of the submissions was transparent and fair, the CCM developed criteria for
review of the Expressions of Interest (EOI) which was included in the advert. However on receipt of the
EOIs it was seen that many smaller groups with less resources had not included enough information for
the review to be fair and equal. As a result all stakeholders submitting EOIs were invited to include
themselves in the clusters discussed above, and more detailed criteria were developed by the Proposal
Development Team (PDT) for review of the Cluster proposals. The criteria developed were submitted
by the PDT for discussion by the CCM and approved by the CCM.
Five Technical Working Groups (TWGs) were then set up to review the proposals submitted. The TWGs
were used to review the proposals instead of the Proposal Development Team, as the majority of the
PDT members had been involved with one of the cluster submissions. The TWGs consisted of CCM and
non-CCM members with skills and competencies from a broad range of stakeholders including multi-
laterals, bilaterals, government and civil society. The TWGs were oriented through an introductory
meeting and next a full day workshop, with an emphasis on professionalism, objectivity and
impartiality to mitigate against any perceived conflict of interest. The five TWGs focused on the four
thematic areas of the National Strategic Framework – Prevention, Treatment, care & support, Impact
Mitigation and Response Management, as well as Monitoring and Evaluation. The TWGs reviewed the
proposals based on the quality and relevance of activities proposed to the National Strategic
Framework, and the priorities identified by the CCM in the Concept Note.
Moreover, the CCM engaged a Gender Specialist to support the integration of gender into the country
proposal. The Gender Consultant reviewed all the submissions made to the call for Expressions of
Interest by the CCM; and supported the TWGs in their proposal review.
TB Process
Meetings for the TB proposal were held to incorporate all inputs from stakeholders into the TB
proposal. Furthermore, specific meetings were held between the writing team and key organizations
(Government, CBOs and FBOs) who submitted proposals. This ensured that all stakeholders’ inputs
were adequately discussed negotiated and reflected in the final proposal including the implementation
arrangements. The submissions from the various stakeholders were examined by specific working
groups on the various priority interventions and presented to a plenary session which reviewed the
submission, made inputs and agreed on integration within the overall proposal. The plenary meetings
were well attended and participatory.
(c) Describe the process used to ensure the input of people and stakeholders other than CCM (or
Sub-CCM) members in the proposal development process.
HIV Process
To seek as broad input as possible from non CCM stakeholders:
 All information relating to the proposal process was disseminated widely, through a variety of
media, to all stakeholders actively involved in the fight against HIV/AIDS; in particular aiming to
reach the broad range of non-government stakeholders and constituencies at the community
level.
 A National Validation Workshop was held to discuss the process with a broad range of external
stakeholders and to get their inputs to the concept paper on national priorities.
 A National Proposal Development Workshop was held:
 To ensure that all stakeholders were made aware how to apply to the CCM
 To ensure that all sectors and groups were aware of the opportunities
 To ensure that the relevant documentation and information was made available
 To demystify some of the jargon related to the Global Fund
 The process of forming clusters to submit proposals ensured that larger, established
ROUND 10
organisations partnered with smaller and marginalised groups, and supported their proposal
development.
 Additional consultations with stakeholders included a session on the Global Fund Round 10
process at a National Gender Consultative Workshop on Universal Access for Women & Girls, and
a number of outputs from the action plans drawn were included in the Round 10 country
proposal.
 The support of the gender consultant working directly with all the clusters ensured that those
clusters consisting of smaller community groups, or those with less resource had additional
capacity and information to develop their proposals.
 The work of the Technical Working Groups and the proposal development team was fed back to
all constituencies at a further meeting on August 16th.
TB Process
Stakeholder workshops were held during the proposal development process as a means of bringing
together all stakeholders beyond the CCM and to ensure the incorporation of their inputs. At the first
workshop conducted in June 2010, all major stakeholders including the business sector, private sector,
SWANNEPHA and CBOs were involved. The concept of the round 10 proposal was discussed in that
forum, and inputs were solicited from all key stakeholders. These inputs were received by the proposal
writing team and refined through separate meetings with leaders of the specific groups. At the second
workshop, the teams proposed detailed activities and sub-activities, which were then discussed and
agreed upon.
HIV-TB 23Minutes
(d) Attach a signed and dated version of the minutes of the meeting(s) at dated 16/08/2010
which the CCM (or Sub-CCM) members decided what to include in each and Concept Note
disease proposal. and HIV 1-9 and TB
(A-N)
2.2.3 Process to oversee program implementation
(a) Describe the process used to ensure the input of stakeholders other than CCM (or Sub-CCM)
members in the ongoing oversight of program implementation.
The CCM has an Oversight Committee which is charged with carrying out oversight of Global Fund
grants. This committee has recently developed Oversight Manual which guides its operations, following
guidance and technical support from Grant Management Solutions (GMS). The manual is based on
reflects on practices and guidelines as articulated in the most recent Global Fund note on oversight
(2010). It is now at the point of implementation.
In order to strengthen the CCM structures, constituency representatives on the CCM were asked to
nominate names of professionals with experience and skills in financial management, grant
management, procurement and M&E. These lists are to include experts from outside of the CCM. The
Secretariat will, from the list of professionals from both CCM and CCM Members, form Technical
Working Groups (TWGs). These will be approved by the Oversight Committee and CCM. The TWGs will
be charged with analyzing reports from PRs in respect of grants performance and will be accountable
to the Oversight Committee and through them to the CCM.
Oversight and field visits reports and other CCM information will be made available to the public
through media and website periodically. Periodic surveys will be conducted with various CCM and non-
CCM stakeholders including the general population to get views and feedback on grant implementation
of Global Fund grants. Feedback will be shared with the CCM with a view to shaping future oversight
practices and procedures that are more effective and efficient.
(b) Describe the process used by the CCM (or Sub-CCM) to oversee program implementation.
 In order to ensure effective grant oversight, Swaziland CCM has developed an oversight plan
and set up an Oversight Committee that ensures that oversight is carried out in a well
ROUND 10
organized, transparent and documented processes to oversee the implementation of the
programme and to involve a broad range of stakeholders including CCM and Non – CCM
members. The CCM carries out its oversight role through the oversight committee.
 The Oversight Committee meets quarterly.
 The CCM liaises with the PR at each CCM meeting to understand the planned implementation
processes, work plans, budgets, timelines and any resulting legal implications.
 The Oversight Committee reviews the PR quarterly reports in detail and makes a presentation
to CCM of its analysis.
 The Oversight Committee investigates specific issues, including carrying out any necessary site
visits.
 The Oversight Committee makes recommendations to the CCM to help support the PR in
resolving bottlenecks.
 An annual work plan and budget is developed for oversight activities.
Clarified section 2.2.4:

2.2.4 Process to select Principal Recipient(s)
(a) Describe the process used to make a transparent and documented selection of each of the
Principal Recipient(s) nominated in this proposal.
 Explain the process for each Principal Recipient for each disease
The CCM discussed and documented the procedures that would be used to select the HIV and AIDS
Principal Recipient/s (PR) in advance to ensure a transparent process.
1. The CCM discussed the focus of the proposal and agreed that they would aim for dual-track
financing this year, to acknowledge the focus on Community Systems Strengthening and the
current lack of a civil society PR. They also decided that this entity should be a national civil
society entity not an international body, if an appropriate body could be found with sufficient
capacity to take on the demanding role of PR.
2. The CCM Secretariat was asked to develop a call for Expressions of Interest (EOI) to be
advertised widely in the media. This document outlined the minimum requirements for
Principal Recipients as detailed by the GF; the focus of the Round 10 concept note and the
selection criteria that the EOI would be reviewed on. This was circulated to CCM and non-CCM
members for input and amended based on feedback.
3. The CCM also decided to charge a non-refundable fee to all potential PRs to compensate for
advertising, adjudicating and other expenses as the proposal development budget was
inadequate.
4. Newspaper advertisements were made over a period of three days and by the deadline three
EOIs were received. One of these was from a national entity, and one from an international
NGO. The third was a partnership of an International NGO and a national civil society body. As
the GF does not work with partnerships, the CCM discussed options in detail and subsequently
asked the partnership to re-submit as a single entity.
5. The submissions were then reviewed by the Oversight Committee as a preliminary analysis and
scored against the selection criteria.
6. The Oversight Committee met with the full CCM to share their evaluations and the CCM
discussed the analysis.
7. The CCM discussed the scoring and the analysis from the Oversight Committee, and put some
further questions to the PRs who had been invited to attend the meeting. The PRs then left the
meeting and the CCM voted to select both PRs.
The CCM has selected two PRs in line with GFATM dual track financing for the two diseases. These
are NERCHA and CANGO for the government sector and civil society respectively.
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(b) Attach the signed and dated minutes of the meeting(s) at which the  Minutes for CCM
held 11th August 2010
CCM (or Sub-CCM) members nominated the Principal Recipient(s) for and Minutes for CCM
each disease. held 16th August 2010

2.2.5 Non-implementation of dual track financing
Dual track financing means that at least one government sector and one non-government sector
Principal Recipient have been nominated for each disease in this proposal. If relevant, provide an
explanation below as to why dual track financing has not been applied for any of the disease proposals
in this application.
The CCM was able to apply the dual track financing option for HIV proposal. However, for TB disease
the main player is the MoH which is a government sector; hence the rationale to have NERCHA which
had applied for all Government institutions. Further, NERCHA is the current PR for the existing Round 8
TB grant which is being consolidated into single grant with Round 10; and for ease of the consolidation
process, the CCM decided on the same PR for the Round 10 TB proposal.
2.2.6 Managing conflicts of interest
Yes
(a) Are the Chair and/or Vice-Chair of the CCM (or Sub-CCM) from the 
same entity as any of the nominated Principal Recipient(s) for any of
the disease proposals in this application?
No
 go to section 2.2.8
(b) If yes, attach the plan for the management of actual and potential NOT APPLICABLE
conflicts of interest.
 Tick this box to

2.2.7 Proposal endorsement by members confirm that the
Membership Details form,
The Membership Details form has been completed with the signatures of all with signatures of all
members of the CCM (or Sub-CCM) CCM substantive
members, is attached to
the application
ROUND 10
PROPOSAL CHECKLIST: SECTIONS 1 AND 2
List annex name and

Section 2: Eligibility
number
CCM and Sub-CCM applicants only
Process used to invite submissions for possible

2.2.2(a) HIV (1-9)
integration into each disease proposal
Process used to review submissions for possible

2.2.2(b) TB (A-N)
integration into each disease proposal
Process used to ensure the input of a broad range of

2.2.2(c) HIV (10-14)
stakeholders in the proposal development process
Process to oversee grant implementation by the CCM

2.2.3(a) HIV –TB -15
(or Sub-CCM)
Processes used to ensure the input of a broad range

2.2.3(b) HIV-TB-15,16
of stakeholders in grant oversight process
Process used to select and nominate the Principal HIV – TB 17, 18, 19,
2.2.4(a)
Recipient(s) for each disease proposal 20 & 21
2.2.6 Conflict of Interest policy HIV – TB 16
Minutes of the meeting at which the proposal was

2.2.7 HIV – TB 22&23
finalized and endorsed by the CCM (or Sub-CCM)
Endorsement of the proposal by all CCM (or Sub-CCM)

2.2.7 HIV –TB 24
members
Other documents relevant to sections 1 and 2 attached by applicant:

 Add extra rows to this section of the table as required to ensure that documents directly relevant are attached
CANGO Minutes of CANGO Minutes-CCM Representation-Rev Senzo

HIV-TB 25
June 2, 2010 Hlatshwayo Election
Technical Working TWGs Workshop Proceedings @ Esibayeni Lodge

Groups Process of HIV-TB 26
July 10, 2010
ROUND 10 – Tuberculosis
PROPOSAL FORM – ROUND 10

SWAZILAND
SECTIONS 3-5: Tuberculosis
3. PROPOSAL SUMMARY
Option 1: Transition to a single stream of funding by submitting

a consolidated disease proposal
 go to section 3.1 (b)
Relevant sections are marked in RED throughout the

proposal form
3.1 Transition to a single
stream of funding Option 2: Transition to a single stream of funding during grant
negotiation
(a) Select only one of the three  go to section 3.1 (b)
options:
proposal form
Option 3: No transition to a single stream of funding in Round 10

proposal form
(b) For options 1 or 2, list the

grant numbers.
Round 8 TB –SWZ-809-G07-T
3.2 Duration of Proposal Planned Start Date To
Month and year: April 2011 March 2016
3.3 Alignment to in-country cycles

Describe:
(a) how the proposal duration was selected in section 3.2 and how it contributes to alignment with the
national fiscal cycle(s), programmatic reporting, or in-country program reviews; and
(b) the systems in place for regular national program reviews and evaluations (including Operations and
Implementation research).
Swaziland government’s annual planning and budgeting is guided by strategic priorities that are revised
each year for the next fiscal year, which starts in April of the following year. The list of priorities is
guided by the National Development Strategy (NDS) and the Millennium Development Goals. The
planning and budgeting process starts at around November, when all department and program heads
R10_CCM_SWZ_T_PF_s3-5_27Sep10_En 1/86
are called to a meeting in order to align all the following year’s plans with the overall strategic
direction of the government. Similarly, reporting progress is line with the government’s fiscal cycle.
In an effort to ensure successful implementation of the activities in the TB strategic plan, it is desirable
that the Global Fund Round 10 grant commences at the same time as the government’s annual fiscal
year 2011/2012 (April 2011 to March of 2012). The commencement of the GF Round 10 grant will also
coincide with the second quarter of the second year of the current GF Round 8 grant, which will then
enable consolidation of both grants to begin in April 2011. The consolidation will ensure that all
activities being implemented will run without duplication and in line with the timelines of the National
TB strategic plan (2010-2014). The NTCP plans to invite partners for a small external program
evaluation at the start of the consolidated grant in 2011, followed by a mid-term review in 2013 and a
comprehensive program evaluation in 2015. These evaluations form the basis for the NTCP’s new
strategic plan for 2015-2019.
A considerable amount of financial and technical support of the program comes from technical and
implementing partners (URC, WHO, CDC/PEPFAR, KNCV, MSH, MSF). The funding and reporting cycles of
these organizations differ from the NTCP’s (for example, PEPFAR funding and reporting cycle runs from
October to September in the following year and WHO funding cycle is biennial). However, the
organizations try to align their planning as much as possible to the NTCP’s strategic plan and short-term
needs. This is facilitated through quarterly partner coordination meetings.
3.4 Summary of Round 10 Proposal
Provide a summary of the tuberculosis proposal.
Swaziland is currently facing a severe and unprecedented TB, TB/HIV and MDR-TB situation. The
country has consistently had the highest estimated TB incidence per capita (1,198/100,000 population)
in the world over the last five years (WHO Global report 2009). In addition, the country also has one of
the highest HIV prevalence rate in the general population at 26% (SNAP 2009, UNAIDS).
The ever rising case notification rates (currently about 1,083 per 100,000 population in 2009), the very
high HIV prevalence rate among incident TB cases (currently 84% in 2009); and unacceptably high MDR-
TB rate of 7.7% among new cases and 33.9% among previously treated cases points to an even more
severe TB situation than previously anticipated. At the moment, 560 MDR-TB cases have already
diagnosed, which by far exceeds the previously approved GLC cohort under GF R8 grant of 50 patients
in year 1, and 488 cases by the fifth year of the grant, and previous projection of cases.
The National TB programme in collaboration with partners, GF round 3 and 8 has made considerable
progress in laying the foundation for implementation of high quality DOTS, TB/ HIV collaborative
activities including routine provision of HTC in TB clinical settings, provision of cotrimoxazole
prophylaxis and initiation of ART to eligible HIV positive TB patients in TB clinical settings (85% of all
TB cases tested for HIV; 95% of the co infected receive cotrimoxazole, and 20% receive ART), as well as
the establishment of programmatic management of DR-TB. The NTCP is also implementing a GLC
approved cohort of 50 patients with support of GF Round 8 grant. Despite this progress, the country is
in dire need of additional resources to scale up the MDR-TB programme in the next 5 years while
continuing to strengthen and expand quality community based DOTS and TB/HIV integration. In view of
the gravity of the current TB situation in the country, the Government of the kingdom of Swaziland has
decided to declare TB as a national emergency before the end of 2010 (Swaziland TB emergency
declaration technical document 2010 ).
Swaziland’s round 10 proposal is titled: Swaziland proposal to expand access to high quality DOTS,
address TB/HIV co-infection and emergency response to the challenge of MDR-TB through
community participation.
This consolidated GF Round 10 proposal will build upon the existing Round 8 TB grant, to scale up the
MDR-TB programme to treat 4,969 cases in 5 years which will be in addition to the initial 488 MDR-TB
cases planned for in the GF R8 grant. The grant also aims to: increase access to basic microscopy
services in rural areas through a phased expansion of the laboratory network to 12 additional health
facilities in 5 years; strengthen the specimen sample transportation system by adding 5 vehicles to the
existing fleet supported by the GF HSS Round 8 grant; increase capacity of the NRL to perform culture
and DST; decentralize integrated TB/HIV co-management; improve infection control practices in TB
clinical and community settings; and strengthen the community-based DOTS. In addition, Round 10
includes a new objective on Advocacy, Communication and Social Mobilization (ACSM) and Community
Systems Strengthening (CSS). The ACSM interventions will include mobilizing the traditional structures
in the 369 chiefdoms of the country in TB control. ASCM is currently inadequately funded by NTCP and
program partners. The new objective includes strengthening the country’s Stop TB Partnership
initiative which was formally launched in 2009 and its secretariat and human resources are currently
funded through the GF R8 grant.
This proposal adopts the single stream of funding to ease implementation by consolidating the R10 and
R8 grants under a single Principal Recipient with 4 Sub-recipients. The proposed PR for the
consolidated grant is NERCHA (PR for the GF Round 8 grant) and the Sub-recipients are: Good Shepherd
Hospital (GSH), the Swaziland Stop TB Partnership, Medicins Sans frontier (MSF) and University
Research Co., LLC (URC). The GF Round 8 started in January 2010 and the consolidated Round 10
grant, if approved, is planned to start in April 2011. The two grants will be harmonized in the second
year of GF R8 to ensure a smooth and simultaneous implementation of the 2 grants.
This proposal is aligned with and based on the National Tuberculosis Control Program Strategic Plan:
2010-2014, the Swaziland’s Health Sector Response Plan 2008-2013, and the National Strategic
Framework of HIV/AIDS: 2010-2014 and Governments TB emergency action plan 2011 to 2013. In
addition, the new ACSM and CSS objective is also aligned with the NTCP communication strategy. The
first three (3) objectives of this proposal are the same as the three objectives of the R8 with only an
increase in scope, while the fourth objective is a new addition. The total funding request in the
consolidated proposal amounts to US$47,712,654.48 for the 5 year period.
The overall goal of the proposal is consistent with the National TB strategy goal, that is, to contribute
to the achievement of the Millennium Development Goals for TB control by 2015.
The objectives and related service delivery areas (SDAs) are as follows:
Objective 1: Pursue high quality DOTS enhancement and expansion

SDA 1.1 Improving TB diagnosis (continuing R8 with increase in scope)
SDA 1.2 High quality DOTS (continuing R8 with increase in scope)
SDA 1.3 Patient support (continuing R8 with increase in scope)
SDA 1.4 M&E and impact measurement (Continuing R8 with increase in scope)
SDA 1.5 Human Resource Development (New but will streamline some R8 interventions)
SDA 1.6 Program management and Supervision (continuing R8 with streamlining of activities)
SDA 1.7 Technical and Management Assistance (Continuing from phase II of R8 and increase in scope)
Objective 2: Address TB/HIV

SDA 2.1 TB/HIV collaborative activities (scale up of R8)
SDA 2.2 Infection Control (continuing R8 with increase in scope)
SDA 2.3 High Risk Groups (continuing R8 with increase in scope)
Objective 3: Prevention and Management of drug resistant TB

SDA 3.1 Drug resistant TB treatment (Scale up of R8)
SDA 3.2 MDR-TB treatment support (Scale up of R8)
Objective 4: Empower people with TB, and communities

SDA 4.1 Advocacy, Communication and Social Mobilization (New)
SDA 4.2 Stop TB Partnering initiatives at country level: strengthening and maintenance of the
Swaziland Stop TB Partnership (New but will include R8 activities)
SDA 4.3 CSS: Building community linkages, collaboration and coordination (New)
SDA 4.4 CSS: Human resources: skills building for service delivery, advocacy and leadership (New)
SDA 4.5 CSS: Community based activities and services - delivery, use and quality (New)
The key populations targeted in this proposal include:

- TB/HIV co-infected, and PLWHA
- Prison populations
- Drug resistant TB patients
- Children
- Young girls and women
- Young boys, men
- Youth in general
- CBOs/NGOs and FBOs
- General population especially the rural poor
The priority interventions targeting these groups are:
DOTS expansion and decentralization of TB services

- Expand access to TB care and treatment
- Community involvement in DOTS
TB/HIV & PLWHA

- Comprehensive and Integrated TB/HIV care; including early and timely provision of ART for co-
infected TB/HIV patients within TB clinical settings (one-stop-shop)
- Pre-ART care services like cotrimoxazole prophylaxis for TB/HIV co-infected patients
- TB Infection prevention and control measures at all facilities with TB patients
- Adequate Personal Prevention equipment infection control measures (respirators and surgical
masks) for HCWs and patients
Prison populations
- To establish a comprehensive TB/HIV prison program
Drug resistant TB patients

- Procurement of second line anti-TB drugs for additional number of patients (expanded cohort) and
GLC cost-sharing;
- Decentralization of MDR/XDR-TB and TB/HIV management (MDR-TB mobile clinical teams, sputum
sample transport system, laboratory quality assurance system)
- Strengthen patient support including nutritional and psychosocial support
Children:
- Training of clinicians on management of childhood TB
Young girls and boys; men and women

- Information, education and communication activities through various channels: print media, radio,
television, internet, church leaders and chiefs, traditional healers, schools, NGOs/CBOs/FBOs,
sports events, World TB Day and traditional reed dance events for girls and boys
- Enablers for CBOs/NGOs/FBOs for screening and referral services, patient follow-up and treatment
support, community sensitization activities, advocacy and lobbying; gender sensitive and stigma
fighting activities and training on income generating activities
Government officials:
- Sensitization meetings with parliamentarians on TB
CBOs/NGOs/FBOs
- Strengthen capacity of the Stop TB Partnership as a forum for TB stakeholders in Swaziland
according to the international STOP TB model
Community leaders
Advocacy, dialogues and engagement in TB control including:
- Sensitization of 369 traditional leaders (Chiefs) on TB
- Sensitization of 369 Heads of Maidens
- Sensitization of 369 traditional healers
The planned outcomes of the interventions described in this proposal are:

- Improved access to high quality TB diagnosis and treatment especially to rural, poor and other
vulnerable populations;
- Improved TB treatment outcomes;
- Improved prevention, rapid detection and treatment of drug-resistant tuberculosis patients;
- Strengthened implementation of collaborative TB/HIV activities;
- Strengthened implementation of infection control measures and practices;
- Increased awareness and partnership for TB control;
List of Acronyms
ACSM Advocacy, Communication and Social Mobilization

AFB Acid-fast bacilli
AMICAALL Mayor’s Alliance for HIV and AIDS in municipalities
AIDS Acquired Immune Deficiency Syndrome
ART Antiretroviral therapy
ARV Antiretroviral drug
Baylor Baylor Paediatric Centre of Excellence
CBO Community Based Organization
CB-DOTS Community Based DOTS
CHC Community Health Centre
CHW Community Health Worker
CDR Case Detection Rate
CDC Centre for Disease Control
CMS Central Medical Stores
CNR Case notification rate
COE Centre of Excellence
C&T Counselling and Testing
CSO Civil Society Organization
CSS Community Systems Strengthening
DCU Disease Control Division
DFID UK Department for International Development
DHS Director of Health Services
DST Drug Sensitivity Testing
DTC Diagnostic Testing and Counselling
DOTS Directly-Observed Treatment, Short course
DRS Drug resistance survey
GDF Global Drug Facility
GF Global Fund to fight AIDS, Tuberculosis and Malaria
GFATM Global Fund to fight AIDS, Tuberculosis and Malaria
GLC Green Light Committee
GSH Good Shepherd Hospital, affiliated with Nuffield Research Institute
EGPFA Elizabeth Glaser Paediatric Foundation
EQA External Quality Assurance
ICAP International Center for AIDS Care and Treatment Programs
HBC Home based carer
HCW Health care worker
HR Human Resources
HRD Human Resource Development
HIV Human Immunodeficiency Virus
HISCC Health Information Systems Coordinating Committee
HMIS Health Management Information System
HTC (provider initiated) HIV testing and counselling
ICAP International Center for AIDS Care and Treatment Programs, Columbia University
IEC Information, Education and Communication
IPT Isoniazid Preventative Therapy
IUATLD International Union against Tuberculosis and Lung Disease
JICA Japanese International Corporation Assistance
KNCV Royal Netherlands Tuberculosis Foundation
MDG Millennium Development Goals
MDR-TB Multidrug-Resistant Tuberculosis
MOHSW Ministry of Health and Social Welfare
MOF Ministry Of Finance
MSF Medecins Sans Frontieres
SNAP Swaziland National AIDS Programme
NCC TB/HIV National Coordination Committee for TB/HIV Collaborative Activities
NERCHA National Emergency Response Council on HIV/AIDS
NGO Non-Governmental Organization
NTCP National Tuberculosis Control Programme
NLS National Laboratory Services
NRL National Reference Laboratory
OPD Out-patient department
PEPFAR The President’s Emergency Plan for AIDS Relief
PHC Primary Health Care
PHU Public Health Unit
PLWHA People Living With HIV/AIDS
PMTCT Prevention of Mother-To-Child Transmission
PRSAP Poverty Reduction Strategy and Action Program
PPM Private-Public Mix
QA Quality Assurance
RFM Raleigh Fitkin Memorial hospital
RHM Rural Health Motivator
R&R Recording and Reporting
R8 or R10 Round of the Global Fund
S Streptomycin
SADC Southern Africa Development Community
SASO Swaziland Aids Support Organization
STI Sexually Transmitted Infections
SNA Swaziland Nurses Association
SNACS Swaziland National Association of Civil Servants
SNAP Swaziland National Aids Programme
SNRL Supranational Reference Laboratory
SWANNEPHA Swaziland Network of People Living with HIV and AIDS
SWABCHA Swaziland Business Coalition against HIV/AIDS
TBCAP Tuberculosis Control Assistance Program
TB Tuberculosis
UNAIDS Joint United Nations Programme on HIV/AIDS
UNISWA University Of Swaziland
URC University Research Corporation
USAID United States Agency for International Development
VCT Voluntary Counselling and Testing
VHW Village Health Worker
WHO World Health Organization
CDC Centers for Disease Control and Prevention, (USA)
CTBC Community tuberculosis care
DHS Demographic health survey
UNGASS UN General Assembly Special Session
UNDP United Nations Development Programme
URC University Research Co.,LLC
USAID United States Agency for International Development
WHO World Health Organization
XDR-TB Extensively Drug-Resistant Tuberculosis
4. PROGRAM DESCRIPTION
4.1 National program

Describe:
(a) current tuberculosis national prevention, treatment, and care and support strategies;
(b) how these strategies respond comprehensively to current epidemiological situation in the country;
and
(c) the improved tuberculosis outcomes expected from implementation of these strategies.
The current national TB control efforts in based on strategies articulated in the country’s national TB Strategic
Plan 2010 – 2014, which is aligned with the broader Health Sector Strategic Plan (HSSP 2008 - 2013). The
interventions in the national strategic plan come under 6 objectives in line with the global Stop TB strategy
designed to comprehensively respond to the prevailing epidemiological situation in the country.
The goal of the National TB Strategic plan 2010 – 2014 is to contribute towards achieving the 2015 Millennium
Development Goals (MDG) and Stop TB Partnership targets for TB control. This strategy envisions a Swaziland
nation free from tuberculosis and its socioeconomic consequences. The NTP philosophy of ‘access to all’ as
enshrined in the National Strategic plan aims to ensure equitable access to the highest possible quality of TB,
TB/HIV and MDR-TB services to all without any form of discrimination.
The main outcomes expected from the implementation of these strategies include:
 Reduction in TB mortality,
 Reduction in TB incidence
 Reduction in TB prevalence
 Increased proportion of TB patients successfully treated under DOTS (from 58% in 2008 to 85%) by the end
of the project proposal period.
The strategic approaches and interventions are as follows:
Enhancement and expansion of High quality DOTS
This includes strengthening laboratory services and coverage at all levels with the view to ensuring timely access
to quality-assured diagnostic services that will respond to the low access among the rural population to reduce the
turn-around-time for basic microscopy, culture and DST, and minimize diagnostic and treatment delays. This is
also aimed at reducing the proportion of pulmonary TB cases diagnosed without any smear result from the current
26% to below 5% by the end of the strategic plan period. The strategy also seeks to implement molecular
techniques for rapid identification of drug resistant tuberculosis especially with the high HIV prevalence of 80%
among incident TB cases. To ensure access to the most remote areas, the national sample transportation system
will be expanded, and quality assurance for microscopy culture and DST will be strengthened at all levels of the
laboratory network. The strategy also includes the pursuance of rapid decentralization of TB treatment initiation
sites, provision of quality-assured first line anti-TB drugs through the GDF mechanism, enhanced programme
supervision and patient support to increase treatment success rate.
Address TB/HIV, MDR-TB and other challenges
The national strategy responds to the current high TB/HIV co-infection rate occasioned by the generalized TB
epidemic in the country. The priority is to integrate and deliver TB (TB screening and INH prophylaxis) and HIV
related services (HIV testing, Cotrimoxazole preventative therapy and provision of ART) as a comprehensive
package; and decentralize services to all health care facilities in the country. This includes integration of TB/HIV
services into the antenatal services. The programme currently tests over 80% of TB cases and given the recent
WHO recommendations of ART for all TB patients regardless of CD4 count, the priority of the country is to scale up
timely initiation of ART for TB patients from the current 25% to at least 70% by 2014. The strategy also seeks to
implement systematic TB screening among high groups including diabetic patients and prisoners. Young girls and
boys will be specifically targeted given the disproportionate effect of TB and HIV among this group. The strategy
links intensified TB screening with provision of INH prophylaxis and TB infection control in the context of the 3 I’s
to decrease nosocomial TB transmission to health care staff, other patients and the public. These interventions are
expected to result in improved integrated management of co-infected individuals and decreased TB/HIV related
mortality.
The national strategy responds to the threat of MDR/XDR-TB by adopting a comprehensive programmatic
management of drug resistant tuberculosis by strengthening surveillance, enhancing rapid diagnosis and providing
quality clinical management and patient support in line with WHO/GLC recommendations. The strategy also seeks
to decentralize management of MDR/XDR-TB as nearer as possible to patient’s homes.
Contribute to Health systems strengthening:
To address one of the key TB diagnostic challenges in high HIV prevalence setting like Swaziland, the national TB
strategy aims to strengthen the radiological services to enhance diagnosis of smear negative TB as well as
childhood disease as part of the programme’s contribution to the overall health systems strengthening.
Furthermore, the strategy responds to high proportion of respiratory symptomatic among (>25%) among OPD
attendees and the need to increase TB case detection by planning to implement the PAL strategy (Practical
Approach to Lung Health).
Engage all care providers:
The Strategy acknowledges the value of engaging providers outside the public sector who considerably contribute
to the provision health care in the country. This includes Faith-based organizations, NGOs and private
practitioners. An estimated 30% of the Swazi population receives health care from FBOs, while the private sector
provides another 10-15%. The strategy is to expand this partnership in a functional collaboration under the
umbrella of the Swaziland Stop TB strategy. MoUs are signed with private providers.
Empowerment of patients and communities to participate in TB control
This is based on the country’s principle of empowerment of individuals on matters relating to their health. The
strategy includes interventions to empower patients through patient literacy initiatives; empower communities
through communication and social mobilization and advocacy to government to main high level of political
commitment to TB control. This also takes into consideration that the current TB problem is overwhelming and
cannot be addressed by health care providers alone. The desired outcome is increased and sustained funding for
TB control. The expected outcomes of these interventions are increased knowledge about TB and enhanced health
seeking behavior.
Enabling and promoting programme-based operational research.
The strategy aims to strengthen national capacity to conduct programme-based operational research to provide
evidence that will inform planning and implementation of interventions including measurement of impact. Under
this objective, national programme staff will be trained on research methods, which will be linked to development
and implementation of research proposals on identified priority areas.
4.2 Epidemiological profile of target populations

(a) Describe the current epidemiological profile of the target populations, and how this profile is
changing with respect to tuberculosis.
Swaziland has the highest estimated TB incidence in the world (WHO2009); the country’s HIV
prevalence of 26% in the general population is also one of the highest in the world (MOH SNAP 2009);
and 80% of incident TB cases are also co-infected with HIV. The country has experienced a dramatic
increase in TB cases since the 1990s due to HIV/AIDS (Figure 1). The whole situation is now complicated
by an excessively high MDR-TB burden. A recently conducted country-wide anti-TB drug resistance
survey among TB patients by Ministry of Health Swaziland in collaboration with Medecins Sans
Frontieres (MSF) and WHO revealed an MDR rate of 7.7% among new and 33.9% among previously
treated TB cases, which are considerably high relative to the neighbouring countries (Swaziland DRS
Report 2010).
These epidemiological figures pose a significant burden on the health service structures in the whole
country. This is against the backdrop of severe human resource shortage. The Swaziland Government
has approved declaration of TB as a national emergency and launch of emergency interventions to
contain the dual epidemic in a comprehensive manner. The official declaration is expected before the
end of 2010.
The 2009 NTCP data shows that case finding and case management has considerably improved
compared to the last two years. As figure 1 below shows, case finding of all cases has picked up in
2009, with an increase of 14%. 390 more sputum smear positive cases, 675 more sputum smear negative
cases and 102 more Extra-pulmonary TB cases have been notified in 2009 compared to 2008. The case
notification rate has increased from 966 to 1,083 per 100.000 population which is among the highest in
the world. Given the grave HIV burden in the country and high TB/HIV co-infection rate of 84%, much
more smear negative and EPTB cases would be expected, pointing towards a gap in case finding in
those types of TB cases. With more intensified case finding activities planned in 2010 and 2011, case
notification is expected to further increase in the coming years.
Figure 1
Swaziland’s high TB, HIV and TB/HIV burden affects women and men in different age groups in
different dimensions. Women are disproportionately affected by the HIV burden especially in young
women of 25-29 years who have an HIV prevalence rate of 49% compared to 45% among their male
counterparts. Furthermore, the HIV prevalence rate among antenatal care clients is estimated at 42%
(DHS 2008).
On the other hand, tuberculosis remains the leading cause of morbidity and mortality among adults in
Swaziland. It is estimated that TB kills 40% of HIV infected patients. Young women in the age group 15-
34 years are the most affected (Figure 2 below). In 2009, smear positive notification was 3,498 cases of
which 1,835 were females (52.5%). The most affected age group is women 25-34 years contributing to
22% of all confirmed sputum smear positive cases. In the age groups above 35 years males are more
affected indicating that females tend to get infected earlier in their lives compared to their male
counterparts. This trend correlates with the HIV infection patterns by age and gender in the country. In
2009, more women than men were tested for HIV (55% vs 45% among new ssm+ and 53% vs 47% among
all cases). Social factors (reluctance to use condoms, men having multiple concurrent sexual
partnerships, lack of knowledge about HIV, sexual violence against women) contribute to a high HIV
prevalence especially among women. These may constitute the root causes for the higher TB
prevalence among women.
Figure 2
Figure 3 below summarises the key treatment outcomes indicators monitored by the NTCP. There was
an increase of 14% for the Smear Positive PTB cases cured in 2008 and a similar decrease in the
unfavourable outcomes: defaulters/treatment interrupters, transfer out and cases that were not
evaluated. On the contrary, treatment failures have increased steadily over the past years, which are
probably related to drug resistance among new cases which is in concurrence with the recent DRS that
showed MDR-TB rate of 7.7% among new cases. Mortality rates have also increased in the last 3 years.
This could be because of undiagnosed MDR-TB, delayed initiation of ART, inadequate patient support
and delayed health seeking. Furthermore, the country’s epidemiological situation is inextricably linked
to other socio-economic health determinants; for example, 60% of Swazis are said to be living below
the food poverty line (Swaziland PRSP 2006).
Figure 3
(b) Do the activities in the proposal target:
Whole country Specific geographic region(s) Specific population group(s)
Source: The World Bank 2004
(c) Size of target populations
Population Groups Population Size Source of Data Year of Estimate
Total country population (all

1,018,449 Population and Housing Census 2007
ages)
Females 10-14 years 70,541 Population and Housing Census 2007
Males 10-14 67,688 Population and Housing Census 2007
91,380 Swaziland Demographic and

Couples 2007
Health Survey
12, 913 Estimate from community

Community leaders 2009
mapping survey
(d) Tuberculosis epidemiology of target population(s)
Indicators Number or rate or percentage

(see the footnote under this table for the [Calculation] or
references) Best Low High (reference)
estimate estimate estimate
TB estimates, 2008 (available on http://www.who.int/entity/tb/dots/table4_2_2_gfatm.xls)
a Estimated number of new TB cases (all forms) 14,000 11,000 17.000 (1)
Male 0-14 (5.4% of total number) [5.4% * est.nr new
756 594 918
cases all forms/100]
Female 0-14 (6.5% of total [5.4% * est.nr new
910 715 1,105
number) cases all forms/100]
b Estimated number of new TB cases (all forms) [a/population*100
1,200 980 1,500
per 100 000 population 000]
c Estimated number of new smear-positive
6,100 4,900 7,300 (1)
cases
d Estimated number of new smear-positive [c/population*100
520 420 630
cases per 100 000 population 000]
e Estimated prevalence of TB cases (all forms) 9,000 4,700 15,000 (1)
f Estimated prevalence of TB cases (all forms) [e/population*100
770 400 1,300
g Estimated number of deaths due to TB (all
360 0 1,000 (1)
forms) among HIV-negative people
h Estimated number of deaths due to TB (all 31 0 88 [g/population*100
forms) among HIV-negative people per 100 000]
000 population
i Estimated number of HIV-positive new TB 12,000 9,000 16,000 (1)
cases (all forms)
j Estimated number of HIV-positive new TB [i/population*100
1,000 770 1,400
cases (all forms) per 100 000 population 000]
k1 Estimated % of MDR-TB among new TB cases National survey on
the prevalence of
anti-TB drug
7.7 4.8 10.5 resistance in the
Kingdom of Swaziland
2009
k2 Estimated % of MDR-TB among previously National survey on
treated TB cases the prevalence of
anti-TB drug
33.8 28.3 39.3
resistance in the
Kingdom of
Swaziland 2009
Indicators Number or rate or percentage
(see the footnote under this table for the [Calculation] or
references) Best Low High (reference)
estimate estimate estimate
TB notifications, 2008
l1 Number of new TB cases (ss+, ss-/unknown,
8,246 (3)
extra pulmonary) notified in 2008
l2 Number of new TB cases (ss+, ss-, extra
pulmonary) and retreatment TB cases
9,565 (3)
(relapse, after failure, after default, other)
notified in 2008
m Number of new TB cases (all forms) notified [l1/population*100
706
n % of estimated new TB cases (all forms)
61 51 76 [l1/a*100]
notified
o Number of new smear-positive TB cases
3,105 (3)
notified
Male 0-14 29
Male, 15-44 1,140
Male, 45 and more 308
Female 0-14 39
Female 15-44 1,399
Female, 45 and more 190
p Number of new smear-positive TB cases [o/population*100
266
notified per 100 000 population 000]
q % of estimated new smear-positive TB cases
notified - Case detection rate of new smear 51 42 63 [o/c*100]
positive TB
r Number of TB cases all forms (new and (3)
retreatment) that were tested for HIV 6,805
s % of TB cases all forms (new and

71 [r/l2*100]
retreatment) that were tested for HIV
t Number of notified TB cases all forms (new (3)
and retreatment cases) that were found or 5,699
known to be HIV-positive
u % of all estimated HIV-positive TB cases that
were found or known to be HIV-positive - 47 36 63 [t/i*100]
case detection of HIV+ TB
v Number of notified HIV-positive TB cases
(new and retreatment) started or continued 5,414 (3)
on CPT
w % of all notified HIV-positive TB cases (new
and retreatment) started or continued on 95 [v/t*100]
CPT
x Number of notified HIV-positive TB cases new
and retreatment) started or continued on 1.876 (3)
ART
y % of all notified HIV-positive TB cases (new
and retreatment) started or continued on 33 [x/t*100]
ART
z Number of TB cases (new and retreatment)
1,279 (3)
received diagnostic DST
aa Number of multi-drug resistant TB (MDR-TB)
cases notified among new and re-treatment 170 (3)
cases
Treatment outcome, 2007
ab Number of new smear-positive cases
2,879 (3)
registered for treatment in 2007
ac Number of new smear-positive cases notified
2,764 (3)
in 2007
ad % of all notified new smear-positive TB cases
104 [ab/ac*100]
that were registered for treatment
ae Number of new smear-positive TB cases that
1,671 (3)
were successfully treated (2007 cohort)
af % of all new smear-positive TB cases
registered for treatment that were 58 [ae/ab*100]
successfully treated (2007 cohort)
ag Number of new smear positive TB cases that
174 (3)
failed their treatment
ah % of all new smear-positive TB cases
registered for treatment who failed their 6 [ag/ab*100]
treatment (2007 cohort)
ai Number of new smear positive TB cases who
188 (3)
died while on TB treatment
aj % of all new smear-positive TB cases
registered for treatment who died while on 7 [ai/ab*100]
TB treatment (2007 cohort)
ak Number of new smear positive TB cases who
329 (3)
defaulted
al % of all new smear-positive TB cases
registered for treatment who defaulted (2007 11 [ak/ab*100]
cohort)
Other: Number of all children with TB notified
580; 535 NTCP annual report 2009
in 2009 (age 0-4; 5-14)
Distribution of notified TB cases by region
- Manzini 3259 (30%)
- Shiselweni 2700 (24%) NTCP annual report 2009
- Hhohho 3186 (29%)
- Lubombo 1887 (17%)
 Global tuberculosis control: a short update to the 2009 report. WHO/HTM/TB/2009.426
 Multidrug and extensively drug-resistant TB (M/XDR-TB): 2010 global report on surveillance and response.
WHO/HTM/TB/2010.3 – See Annex 6: Estimates of MDR-TB, by WHO region, 2008
 Data from country TB routine recording and reporting system.
4.3 Major constraints and gaps in disease, health, and community systems
4.3.1 Tuberculosis program

Describe:
(a) the main weaknesses in the implementation of current tuberculosis strategies;
(b) existing gaps and inequities in the delivery of services to target populations; and
(c) how these weaknesses affect achievement of planned national tuberculosis outcomes.
The NTCP is currently confronted with the challenge of having to address three emergencies at once:
i.e address a growing MDR-TB burden while strengthening quality basic DOTS; and to scale up
integrated TB and HIV care and infection control given the huge level of co-infection in the country
(84%). The main weaknesses in the implementation of the current strategies of the NTCP are:
1) Human resource crisis

The NTCP struggles with a grave human resource crisis at all levels. Without immediate addition of
trained and skilled staff, the NTCP will not be able to adequately address the massive TB and TB/HIV
burden and the MDR-TB threat in the country. The urgent need to expand DOTS implementation,
decentralize DR-TB management, and introduction of community-based TB program support, more
human resources for the periphery are needed. At the regional and peripheral levels, the current HR
needs are greatest in laboratory services (medical and nursing staff as well). Trainings for physicians
and nurses on diagnosis and treatment of paediatric TB and diagnosis of smear negative TB are urgent.
Adequate staffing levels and a proper working environment with functioning equipment is crucial. All
existing and new staff need to be updated and trained on a regular basis. Ensuring adequate staffing
and training at all levels will ultimately have a positive effect on case detection, treatment outcomes
and, eventually, on the overall TB and MDR-TB situation in the country.
2) Weak sputum smear microscopy network, culture and DST services

Since a functioning sputum smear microscopy network is the cornerstone of each DOTS program, the
strengthening of the laboratory network, its quality assurance system, sample transport, and recording
and reporting will have a direct positive effect on case detection and strengthening of DOTS. In
addition, the internal and external quality assurance of sputum smear microscopy services remains
weak and needs further strengthening. Services for TB culture and drug sensitivity testing have been
re-established, but need considerable further strengthening and additional quality improvement to
ensure fast and reliable diagnosis of drug-susceptible and drug-resistant TB.
3) Limited capacity to respond to MDR-TB burden and decentralize treatment

The TB program has started to respond to DR-TB by developing management guidelines, procuring
second-line drugs, establishing a DR-TB reference center (the new TB hospital) and treating a limited
number of cases. Currently, treatment and management of MDR-TB is centralized at the TB hospital in
Manzini, but patients are not financially supported for the long and expensive trips to Manzini for
review and drug collection, which poses a risk that patients stop treatment because they cannot afford
the transport, therefore the decentralization of care needs to be accelerated. The main concerns are
currently the limited availability of second line drugs, the lack of infection control measures in
hospitals, the lack of trained medical staff and transport to decentralize MDR-TB treatment and
improving access and quality of long-term, chronic care for MDR-TB patients. This initiative needs to be
strengthened in all aspects in order to avert the further spread of MDR-TB /XDR-TB.
4) Weak treatment support and community involvement

Treatment adherence is poor and defaulter and transfer rates remain high, especially among the rural
poor, as a result of limited access to care and lack of community involvement. At present, treatment
services are not sufficiently decentralized and there is not enough trained staff for adequate treatment
support and defaulter tracing. Scale-up of efforts for treatment support and defaulter tracing will be
necessary at all levels in order to improve treatment outcomes and to decrease defaulters and
relapses. A greater involvement of the community will be critical to reach vulnerable populations,
increase access to services and boost case detection and treatment success. In addition, the NTCP’s
ability to reach high-risk groups such as prisoners has been limited.
5) Limited knowledge of true disease burden in the country
The NTCP has been working with the WHO case detection estimates that are – in the absence of a
prevalence survey in the past 15 years – commonly based on the epidemiology of neighboring countries.
There are several reasons why these estimates (61% CDR, all forms) might not be accurate and need to
be urgently revised with a TB prevalence survey: 1) HIV prevalence among the general population in
Swaziland is much higher than in neighboring countries, mainly related to socio-cultural factors that
differ from other countries; 2) Despite being grouped as a lower-middle income country, Swaziland’s
rural population is still very poor (Human Development Index 0,547, 2007) and poverty fuels TB; 3)
WHO estimates on MDR-TB among new cases were below 1% whereas a recently completed drug
resistance survey confirmed the hypothesis of a much higher incidence (7,7% among new cases; 33.8%
among retreatment cases) which has grave consequences for control strategies; 4) It is hypothesized
that the actual numbers of TB in the country are much higher than what is currently estimated. If that
is the case, the national strategy would need to be revised and much more resources would be
necessary; and 5) This would enable the NTCP to advocate for more government commitment to TB
control. Although Swaziland’s case notification rate is among the highest in the world, the current
estimates and the small population prevent Swaziland to be listed under the high TB and MDR-TB
burden countries, which has also stark consequences for (international and national) resource
allocation.
6) Limited capacity in raising awareness about TB, TB/HIV and MDR-TB

Until now, the NTCP has had only very limited financial and human resources to raise awareness and
engage in advocacy, communication and social mobilization activities. High mortality rates indicate
that many TB suspects delay health care seeking. According to findings in the DHS 2006/2007, a
substantial number of the population first seeks help with traditional healers. Improved knowledge
among the population about TB symptoms, TB/HIV and TB treatment would support case detection and
reducing mortality rates. Activities to reduce stigma and discrimination are necessary to promote
equitable access to care, which is not the case currently with women and girls facing multiple
obstacles to health care. Government support to TB control has been steadily increasing but needs
further advocacy for an increase in resources allocated to TB control.
4.3.2 Health Systems

Describe the main weaknesses of and/or gaps in health systems that affect tuberculosis outcomes.
The health system is based on the concept of Primary Health Care, consisting of three levels: primary,
secondary and tertiary. At the primary level, there are community based healthcare workers, clinics
and outreach services. The secondary level comprises health centres which offer both out-patient and
in-patient services. The tertiary level comprises regional hospitals, specialized hospitals and the
national referral hospital. The health service delivery system consists of formal and informal sectors. In
the formal sector, there are public and private health service providers including NGOs, mission,
industry and private practitioners. The informal sector consists mainly of traditional and other
alternative health care providers.
Functionally, the public health system is decentralized from the central Ministry to the four Regional
Health Offices (RHOs) in Hhohho, Lubombo, Manzini and Shiselweni regions. Each Regional Health
Office is headed by a Regional Health Administrator and supported by the Regional Health Management
Team (RHMT). At the community level, there is a network of community health workers including Rural
Health Motivators (RHMs) to promote community participation in health activities in the areas.
In terms of access to services, about 85 % of the population is currently living within a radius of 8 km of
a health facility. Nationally it is estimated that about 20 % of the population does not have access to
health facilities (2008). The rural and poor communities are worse off compared to urban communities.
The quality of care provided remains a challenge due to the heavy disease burden, a chronic shortage
of human resources in the public sector, deteriorating infrastructure, inadequate budget allocations
and weak supportive supervision systems. The pharmaceutical supply management and distribution
system has been weak due to challenges in funding of the system, lack of adequate storage space,
weaknesses in procurement and management systems, which led to the ART and TB program to procure
and distribute the drugs separately. Weaknesses in the separate systems again led to frequent
shortages of anti-TB drugs in the past years.
The health sector faces a severe human resource shortage across all cadres at all levels of the health
system. According to the HMIS 2008 report the doctor to patient ratio is 1.8 / 10.000 population; the
nurse to patient ratio is 28/10.000. The health personnel shortage especially in the public sector is
aggravated by brain-drain to the private sector and more developed economies abroad. Approximately
3.8% of GDP is spent on health care (including private, 2008). Government expenditure on health
accounts for 2% of the GDP. The government allocation to the health sector, although very much
improved at 11.5% (2009), still falls short of the Abuja Declaration commitment of at least 15 %. The
country has one of the highest HIV prevalence in the world at 26% among the sexually active population
with HIV infection higher among women at 31.1% than men at 19% (DHS 2006-7). The number of PLWHA
who need antiretroviral therapy is estimated to be in excess of 60,000. (Source: Ministry of Health of
the Kingdom of Swaziland: National Health Sector Strategic Plan 2008-2013). The HIV/AIDS epidemic
has given rise to a concurrent tuberculosis epidemic in the country, with recorded new cases rising
from less than 1,500 in 1993 to over 11,000 in 2009.
The specific challenges as a consequence of weaknesses of the health system on the national TB
control outcomes are:
1. Human resource crisis

The NTCP struggles with a grave human resource crisis for all cadres relevant to TB Control. Without
immediate addition of trained staff, the NTCP will not be able to adequately address the massive TB,
TB/HIV and MDR-TB burden in the country. The NTCP needs additional central staff to ensure the
overall management of program implementation while strengthening the capacity of existing staff. The
NTCP currently relies heavily on support from partners like WHO, PEPFAR, URC. With the view of
expanding DOTS and introducing community-based program support, more human resources for the
periphery must also be considered. In addition, the implementation of quality TB services is hampered
by inadequate knowledge and skills to suspect, diagnose, and treat tuberculosis. High turn-over of
health workers in addition to frequent staff rotations necessitate continuous training and re-training of
health care workers.
2. Weak Pharmaceutical procurement and supply management system
The weak pharmaceutical supply management and distribution system has over the years resulted in
inconsistent supplies and often serious stock-outs of essential anti-TB drugs for treatment of TB
patients. Interruptions in patient’s treatment may account mostly for the low cure rates and overall
treatment success rates over the especially prior to 2007.
3. Inadequate health infrastructure
Access to diagnosis with sputum smear microscopy and TB culture and DST is weak due to a limited
number of laboratories capacitated to perform AFB, culture and DST. Most of the health facilities in
Swaziland are over-crowed and have inadequate TB infection control provisions in place.
4. Centralization of TB services and inadequate integration in primary health care
With low numbers of tuberculosis in the late 1970s and early 1980s, TB services were centralized at the
TB Centre in Manzini with a central level team visiting all the health care facilities to manage TB
through an entirely vertical program. With the dramatic increase in the TB burden in 1990’s, the
Swaziland government adopted a public health approach to the problem and established a national TB
programme and since then TB services have been decentralized to 29 centres. The level of
decentralization is grossly inadequate given the extent of the TB burden, the high TB/HIV co-infection
rate and the increased MDR-TB cases. The lack of decentralization is still discouraging doctors and
nurses at the service delivery level to participate in TB control, hence the poor case finding and
treatment outcomes, and inadequate integration of TB and HIV services at the peripheral level.
4.3.3 Community Systems

Describe the main weaknesses of and/or gaps in community systems that affect tuberculosis outcomes.
The community system in Swaziland is composed of the following main elements:
1) The traditional structure of chiefdoms plays an important role in community decision-making and
conflict resolution beside the political constituency (Inkhundla) establishment.
2) Rural Health Motivators (RHM) who occupy a key position in community health care serving the
functions of preventive healthcare, treatment support and health promotion (for all disease condition,
but mainly AIDS, TB and Malaria). Each RHM supports approximately 40 households, which can be very
sparsely located; together with Home-Based Care providers (HBC, mainly palliative), these are the two
cadres placed at community level, associated with a clinic. In addition, 3) a multitude of international
and local non-governmental/community-based and faith-based organizations are active in the
community. They either provide health care in their own clinics, or they support government facilities,
they provide home-based care, are linked to treatment support groups, or they simply focus on health
education, prevention and advocacy.
Main weaknesses/gaps
The main weaknesses of this setup are 1) an overburdening, under-resourcing, uncoordinated incentive
structure and under-supporting of rural health motivators. RHMs are commonly volunteer matured or
elderly women who serve their community, with a symbolic appreciation by government with a salary
of E300 (42 USD) per month. Due to an increased focus of government and non-governmental agencies
on the decentralization of health care and community-based treatment, more and more responsibilities
(activities & reporting) are added to the portfolio of the RHMs. Differing incentives provided by various
organizations tend to swing the commitment of the RHMs in favour of the organizations providing the
highest incentives. In addition, the various agencies are not well-coordinated at regional or community
level to avoid duplication of efforts and competing demands for the time of the RHMs. Due to different
salary schemes and attention, HBCs do not receive as much salary and incentives as RHMs which led to
friction between the two cadres. Lastly, with an estimated number of more than 3,000 RHMs and a
total of 6,231 caregivers (RHM and care givers) in the country, the supervision structures are not
adequate enough. Up to 600 RHMs are supervised by a regional RHM manager, whose supervisor is the
regional matron and about 100 Lead RHMs which are supervised by the national RHM program manager
in the MOH. (Source: ICAP Mapping report of community based care and support services in Swaziland,
2009).
These weaknesses mean for the TB program, that RHMs are already over-demanded and cannot serve
the function of tuberculosis treatment supporter. With 11,032 TB cases notified in 2009 and a third of
the population infected with HIV, the disease burden is too high to be served by the common
community structures while especially TB treatment support needs to be strengthened for improved
treatment outcomes.
4.3.4 Efforts to resolve weaknesses and gaps
Describe what is being done, and by whom, to respond to health and community system weaknesses
and gaps that affect tuberculosis outcomes, as outlined in sections 4.3.2 and 4.3.3.
1. Increasing government commitment
The government of the kingdom of Swaziland will increase its commitment to health in the coming
years. HIV/AIDS has been officially declared as an emergency which means an increase of government
resources. Currently, the government is preparing to officially declare TB as an emergency by the end
of 2010. An emergency response plan has been approved.
2. Human resource strengthening
The MOH is currently planning trainings in leadership, governance and management for senior staff; it
is in the process of developing a human resource for health (HRH) strategy and to expand training
facilities for healthcare while developing a national career structure for health programs. There is a
plan to empower the ministry of health to manage HRH instead of the current arrangement where the
ministry of public service hires staff for health. To this end, a bill is currently under consideration of
the Parliament for the establishment of a Health Service Commission with the view to comprehensively
address the issue of human resource for health on a sustainable basis.
The TB program started to address the human resource crisis through Global Fund Round 3 and this
included additional staff for the central unit, trainings for central and peripheral staff, additional
microscopists and laboratory technologists for the periphery and the Central Reference Laboratory. GF
Round 8 includes a health system strengthening component to train phlebotomists in AFB microscopy,
recruiting laboratory staff, RHMs trainings, treatment supporters and cough officers training,
supporting the Wellness Center for HCW’s health care and strengthening the university of health
sciences faculty. In addition, the TB program has succeeded in mobilizing resources from additional
partners such as WHO, URC and KNCV for capacity building activities of NTCP staff.
3. Improving health infrastructure and pharmaceutical supply management
The MOH is finalizing an agreement with the World Bank to strengthen the health system, with the
focus on capacity building of MOH planning, management and governance, infrastructure
rehabilitation, support to training institutions, HIV impact mitigation and maternal and child care. With
World Bank support, TB diagnosis will be strengthened through digital X-ray network. New regional
warehouses for pharmaceutical and health products are being put up with support from GF Round 8 HSS
while structures and management procedures including procurement and supply management are
currently revised. In 2010, the MOH plans to improve the infrastructure of regional health offices with
telephone and internet access. The TB control program is in the course of integrating its supply and
distribution system into the general system and has set an end to drug shortages by establishing a
regular procurement cycle of quality-assured drugs with the Global Drug Facility (GDF support includes
technical assistance). An infection control policy has been developed and roll-out trainings of health
care workers are ongoing. The National Reference Laboratory (NRL) has moved to the new building
where facilities are in the process to be refurbished for adequate infection control required for a BSL
III laboratory. Additional partner support for NRL to introduce new technologies and strengthen existing
ones has been secured (URC, MSF-NL, FIND).
4. Decentralizing HIV care and treatment to increase access to TB patients
The NTCP and MOH ART program are working together to increase access of ARVs for TB patients
through decentralization of ART services in TB clinical settings. Since 2009, the TB program started
implementing ART services in 5 TB clinics. In addition, ART sites are providing TB screening for PLHIV as
well as TB treatment initiation. Harmonization of decentralization of ART initiation sites and TB
initiations is being planned by regional TB and ART teams. From 2008, the number of TB diagnostic
centres has increased from 17 to currently 29 facilities with plans to increase the TB diagnostic sites to
67 by the end of the grant period. The MOH is currently reviving its Health Sector Decentralization Task
Force while deepening decentralization of health care services to chiefdom levels.
5. Strengthening of community systems
The MOH is currently revising the community system to resolve the issues mentioned above: all MOH
partners will need to subscribe to the same indicators to relieve RHMs from too many reporting duties;
the remuneration system of RHMs is currently revisited, the cadres of RHM and HBCs will be merged
and retrained. Currently a pilot is ongoing to test this new system. RHM supervision is planned to be
strengthened. The TB program has started to implement a community-based DOTS program through
Global Fund Round 8 with additional staff in the periphery attached to clinics (see above),
decentralization of treatment from diagnostic center to clinic level and collaboration with community-
based organizations for treatment support, case finding, and trainings.
(Sources: Ministry of Health Annual Action Plan 2010-2013; World Bank Aide Memoire March 2010; NTCP Annual Operational Plan 2010)
4.4 Proposal strategy
Complete this version of section 4.4.1 if the applicant selected option 2 or 3 in section 3.1 of
the Proposal Form
Option 2 = Transition to a single stream of funding during grant negotiation

Option 3 = No transition to a single stream of funding in Round 10
4.4.1 Interventions
 This section should be completed in parallel with the Performance Framework and detailed budget and work
plan
Describe the objectives, service delivery areas (SDA), and activities of the proposal. The description
must be organized in that exact order and the numbering system must match the Performance
Framework, detailed budget and work plan.
The description must identify:

(a) who will implement each area of activity (e.g. Principal Recipient, Sub-recipient or other
implementer); and
(b) the targeted population(s).
FOUR - EIGHT PAGE MAXIMUM
Complete this version of section 4.4.1(a) (b) and (c) if the applicant selected option 1 in
section 3.1 of the Proposal Form
Option 1 = Transition to a single stream of funding by submitting a consolidated disease proposal
4.4.1 Interventions
 This section should be completed in parallel with the Consolidated Performance Framework and detailed
budget and work plan
(a) Overview of programmatic activities
Describe the objectives, service delivery areas (SDA), and activities of the consolidated disease
application. The description must be organized in that exact order and the numbering system must
match the Consolidated Performance Framework, detailed budget and work plan.
The narrative description of the Round 10 interventions should reflect all objectives, service delivery
areas (SDAs), and activities in the Round 10 consolidated disease proposal, but distinguish between
what programming is being continued from existing grants versus new programming for Round 10.
The description must identify:

(1) who will implement each area of activity (e.g. Principal Recipient, Sub-recipient or other
implementer);
(2) the targeted population(s);
(3) what changes in implementation and/or the targeted population(s) have occurred, if any, for
those elements which are from existing grants and continuing in this consolidated disease
proposal;
(4) any links between the existing grant activities to be continued in the consolidated disease
proposal, as these activities previously existed in separate grants;
(5) any links between the proposed activities and existing Global Fund grants for other diseases or
HSS; and
(6) how duplication will be avoided if there are linkages identified in points (4) and (5) above.
The Swaziland Round 10 proposal is a consolidation of round 8 and round 10 priority interventions
aimed at addressing the current gaps occasioned by new TB-related epidemiological developments in
the country. To eliminate duplication, the interventions have been synchronized as follows:
 For continuing activities that do not require increase in scope, Round 10 funding for the same
activity is indicated only after expiration of round 8;
 For continuing activities with increase in scope, the consolidated workplan will provide for the
new target, while the exact contribution of round 10 over the round 8 funding is clearly
indicated in the consolidated workplan including period of implementation;
 For entirely new activities not supported by Round 8, only Round 10 funding will reflect in the
consolidated workplan.
 Possible links between all Round 10 interventions and the current HSS round 8 grant have been
considered to ensure complimentarily.
The Goal of the proposal:

The overall goal of this consolidated proposal is to contribute towards achievement of the MDG targets
for TB control in Swaziland by 2015.
Objective 1: Pursue high quality DOTS enhancement and expansion

Indicators:
 Case detection rate: new smear positive TB cases
 Treatment success rate: new smear positive TB cases Number (%) of TB diagnostic and
treatment centers that reported stock-outs of first line drugs that resulted in the interruption
of treatment during the year out of all TB treatment centers
 New and re-treatment TB patients receiving diagnostic drug susceptibility testing for MDR-TB
among the people eligible for drug susceptibility testing according to national policy
SDA 1.1: Improving TB diagnosis

Implementer: National reference Laboratory (NRL) through SR NTCP; MOH (HSS)
Target population: TB and DR-TB suspects and patients, laboratory staff
This SDA aims to enhance the quality of sputum smear microscopy through strengthening the QA
system, and expanding population access to services through expanding the network as well as linking
the most rural areas through an expanded sample transportation system. The National reference
Laboratory (NRL) will be positioned to provide quality-assured culture, DST and molecular test while
providing QA support to peripheral laboratories.
Indicators: # microscopy centres participating in EQA for microscopy; # number of TB cultures
performed
Changes in implementation: none
Link to Rd 8, HSS: see description
Duplication: there will be no duplication with other diseases or HSS as the lab activities are
coordinated by the head of communicable disease laboratories under which the NRL is housed. All HSS
activities will continue as planned under Rd 8; the additional staff, equipment and refurbishments
come in addition to the ones planned under the HSS grant.
1.1.1 Strengthen and expand basic AFB microscopy services
The proposal seeks to further decentralize the country’s AFB microscopy services to increase access to
diagnosis for the rural population. Therefore, 12 laboratories currently being established through the
Round 8 HSS grant will be equipped in a phased manner within the next 5 years to provide AFB
microscopy. 11 currently existing laboratories will be upgraded, refurbished and equipped within the
first 3 years for infection control and biosafety considerations.
1.1.2 Strengthen capacity of National Reference Laboratory to perform Mycobacterial Culture and DST
including molecular tests for rapid MDR-TB detection:
Equipment will be procured to establish Solid Culture (L-J medium) which is currently unavailable at
the NRL in addition to the liquid (MGIT) system and Line Probe Assay (LPA) to be provided through
collaboration with FIND. Round 10 funding is also required to procure reagents for culture and DST, and
LPA in the 4th and 5th year of the proposal period when FIND’s 3-year support ends. In the coming years,
it is foreseen that the country will pilot the use of Gene Expert (when approved by the STAG) in 2 sites
and then scale up to 6 sites within the proposal period.
1.1.3 Collaborate with Supra-national Reference laboratory for second line DST and EQA
Second-line DST will need to continue in collaboration with MRC South Africa currently funded through
Round 8 support. On a quarterly basis, specimens will sent to the MRC for second line DST for which
R10 funding is required to continue this activity beyond the period of R8 support.
1.1.4 Strengthen national Quality Assurance systems for microscopy, Culture and DST services
The existing national quality-assurance system will be strengthened by provision of a dedicated vehicle
for quarterly EQA supervision, introducing quarterly review meetings for laboratory staff and trainings
of staff on QA. The Round 8 grant funds allowances for laboratory staff on supervision, which will be
continued by round 10 funding in the 5th year of the consolidated workplan. Panel shipment from the
SNRL Pretoria to the NRL will be maintained as well as QA support for culture and DST. This is also a
continuation of the round 8 activities with an increase in scale.
1.1.5 Expand national sample transportation system.
The scope of the current national sample transport system will be expanded to cover the remaining 5
of the 10 planned routes, the other 5 already provided for by the Round 8 HSS grant. This will ensure
that all regions are covered by the sample transportation to reduce turnaround time (TAT) for
microscopy, culture and DST results. Covering the 5 routes requires 5 more vehicles and drivers for
which funding is requested in the Round 10 proposal
To the Left is a picture showing one of the Sample
transportation vehicles procured through the Round 8 HSS
grant. 5 additional ones to be procured using the round 10
grant will enable the whole country to be covered by this
system. The drivers will be phlebotomists to be trained in
taking and handling biological specimen samples. The
Swaziland government meets the costs of cars’ insurance,
fuel and maintenance.
1.1.6 Enhance laboratory safety practices

This proposal seeks to ensure maintenance of laboratory Biosafety equipment (HEPA filtration system
and biosafety cabinets) at the NRL and regional and other laboratories through a reliable maintenance
contract. Maintenance will be carried following a strict schedule of six-monthly servicing and
replacement of filters. Furthermore, emergency spill kits, first-aid boxes, and smoke test guns will be
procured and supplied to all laboratories. Round 8 supports maintenance the system only in the NRL,
while Round 10 will include support for 8 other laboratories in 8 TB diagnostic sites.
SDA 1.2. High quality DOTS

Implementer: NTCP
Target population: TB suspects & patients
This SDA is primarily concerned with strengthening the quality of basic DOTS; and decentralization TB
services, which requires building the capacity of the health facility in terms clinic space/furniture and
training of health care providers.
Indicators: # health facilities enrolling and initiating TB patients on TB treatments
Duplication: none, the clinics will receive furniture based on a need assessment.
1.2.1 Decentralize TB treatment initiation and care services
The proposal seeks to support the decentralization of TB treatment initiation from the current 29 to 67
facilities; and increase number of facilities providing continuation phase from the current 102 to 209 to
cover the whole country in the next 5 years. The decentralization process will follow a phased
implementation which will be preceded by an assessment of the capacity of the facilities, provision of
essential furniture and training of staff on TB on basic DOTS, TB/HIV and DR-TB which is included under
SDA 1.5 Human resource development below. Round 10 funding is required to complement (top-up) the
training budget of R8 for training of health care worker due to increased number of facilities to be
involved; purchase of basic set of furniture for the new DOTS sites and instituting infection control
measures.
SDA: 1.3 Patient support

Implementer: SR NTCP, SR GSH
Target population: all TB, TB/HIV and MDR-TB patients.
This SDA focuses mainly on increasing treatment success rate by ensuring treatment adherence through
patient support using a multi-pronged approach.
Indicators: # (%) of new TB patients who are supported (including daily D.O.T.) by the community
throughout treatment among estimated new TB patients
Changes in implementation: In Rd 8, the NTCP planned to introduce community treatment supporters
(similar to RHMs) to link clinics and TB patients. This structure has been revised as RHMs are
completely overburdened and more support is needed at clinic level.
Duplication: No duplication. The HIV program also provides for one expert client at the clinic, so
together there will be 2 per clinic which will both do TB/HIV activities. Equipment for nutrition
provision is provided by UNAIDS.
1.3.1 Strengthen and expand defaulter tracing system:
The current system of engaging local CBOs under the round 8 grant to follow up patients will be
expanded by including 3 additional CBOs using round 10 funding. Additional 15 adherence officers will
be hired and equipped with motorbikes and training for the newly established diagnostic facilities to
cater for the additional TB initiation sites to be established. This will complement the 17 Adherence
Officers supported through R8 to a total of 32. All Adherence Officers will be equipped with mobile
phones and air-time to facilitate follow-up which is a new initiative in Round 10.
1.3.2 Recruit 61 expert clients for TB/HIV
Through R10 funding, 61 facility-based Expert Clients will be hired and remunerated to facilitate DOT
and nutrition provision, counseling, triage, adherence, and to link up with patient’s personal treatment
supporter (family member or friend). This is meant to relieve nurse’s workload to enable them
discharge clinical duties efficiently. There are currently 162 expert clients, so there is need to scale up
to 323 over 5 years = 61 additional ones. This activity is new and is costed under the budget line 1.6.1
which is the SDA for human resources.
SDA 1.4: M&E and impact measurement

Implementer: SR NTCP
Target population: general population, NTCP, TB patients
This SDA aims to strengthen the routine surveillance system to ensure data quality and consistency of
reporting. Will also include a repeat anti-TB drug resistance survey to be conducted by the end of the
proposal period. The programme’s M&E systems capacity will be re-assessed and strengthened.
Indicator: # (%) of supervisory visits performed by the central NTCP to the diagnostic sites / out of
planned visits (quarterly)
Duplication: none; all activities under the HSS grant will continue as planned in Rd 8, they are mainly
focussing on national MOH level.The Rd 10 suggested activities are specifically for TB.
1.4.1 Maintain Electronic TB recording and reporting system
Round 10 funding will be used to maintain the current electronic TB recording and reporting system
from 2012 when PEPFAR/CDC support for this activity expires. The maintenance package includes a
service, software upgrade, training and technical assistance agreement with the software developers.
Furthermore, additional desktop computers will be procured for the new diagnostic centers to be
added to the system; and to replace non-functional ones. An Electronic Medical Records (EMR) for MDR-
TB management will also be linked to the overall NTCP system. In the mean-time paper-based
recording and reporting tools are needed for all facility- and community-based activities.
1.4.2 Review/update and print TB, TB/HIV and MDR-TB recording and reporting materials
The proposal will support the regular review of the various TB recording and reporting materials and
ensure that they are printed in the required quantity for effective monitoring and evaluation of the
programe. The quantification for these materials will be based on the programme needs annually.
1.4.3 Conduct quarterly Data Quality review meetings
Data management will be strengthened at national and regional levels through quarterly review
meetings in the 4 regions. While round 8 grant currently supports national level review meetings,
Round 10 funding will be required for the regional level meetings. Round 10 funding will also continue
funding national meeting in the 5th year of the proposal period when Round 8 funding ends. At the
regional level, two full days meeting will be conducted with participation of all clinics in the region
Costs include accommodation, incidentals, transport and stationery.
1.4.4 Conduct periodic review of the national TB programe
To evaluate its effectiveness and to receive guidance, the program plans to hold two small external
program reviews (in the beginning of the grant and at mid-term) and one at the end of the five years to
form the basis of the new strategic plan 2015-2019. Round 10 funding is required to fund the
participation of local NTP, Laboratory, Pharmacy, Health facility and community level staff in the
review, which is not provided for in the round 8 grant.
1.4.5 Conduct repeat anti-TB Drug Resistance Survey (DRS)
As a follow up to the DRS conducted with assistance of MSF in 2009-2010, this proposal will support a
repeat survey to be conducted in the 5th year of the proposal period with the view to determining the
trends and patterns of drug resistance in the country.
1.4.6: Conduct M&E System Strengthening self assessment and implement strengthening action plan
The PR in collaboration with the National TB Programme and all stakeholders will conduct an M&E
systems strengthening self assessment workshop as a follow up to the one of 2008 in the first quarter of
2011 before round 10 grant start date. Funding requested for the workshop and implementation of
strengthening action plan to be developed.
SDA 1.5 Program management and Supervision

Implementer: SR NTCP, PR NERCHA
Target population: NTCP staff
This SDA is mainly concerned with further strengthening of supervision of implementation and ensuring
effective partner coordination.
Indicator: # (%) of supervisory visits performed by the central NTCP to the diagnostic sites / out of
planned visits (quarterly)
Duplication: none. The NTCP coordinates its partners in quarterly partner coordination meetings and
all partners were involved in developing the national strategic plan and annual operational plan to
avoid duplication of resources.
1.5.1 Conduct biannual Partner’s Coordination meetings
With increased program activities, good partner coordination is a must. So far, the program did not
have funding to hold regular meetings, therefore this proposals includes seed-funding for quarterly
partner coordination meetings.
1.5.2 Conduct quarterly TB Technical Working Group (TWG) meetings
This proposal seeks to strengthen the programme’s technical coordination through quarterly meetings
of the in-country TWG to discuss technical matters relating to the national TB programme, review
technical protocols and guidelines and advice the NTP and MOH accordingly. The costs involved include
cost of venue and refreshments of participants as it will be non-residential one day meetings.
1.5.3 Support NTCP Administrative and coordination costs
With increase in NTCP staffing levels, more equipment is needed (mainly computers), as currently
some staff rely on their personal computers to work. The NTCP Office rent currently paid through the
Round 8 grant will be continued. The payment of the PR support and overhead costs started under the
round 8 grant will continue with an increase in scale due to the increased volume of grant funding as
well as the additional Sub-recipients to be engaged (The Stop TB Partnership, MSF, and URC). For
program management and capacity building purposes, at least 2 program staff should participate in the
International Conference on Lung Health every year. The costs should include participation in a
Postgraduate Course at the conference on key programme areas. Round 10 funding request with
respect to this activity is to increase the number of participants supported by round 8 to include a
participant from the Laboratory and Pharmacy departments.
SDA 1.6: Human Resource Development

Implementer: NTCP, NRL, MOH (HSS)
Target population: NTCP, TB suspects and patients; NTCP, lab and clinicians including medical officers
and nurses, CBO/NGOs, journalists, schools, prison staff.
Indicator: Number of NTP positions filled according to HRD plan
Changes in implementation: Participation in Union conference will be under SDA 1.5 in Rd 10
Duplication: the additional staff are complementary to the ones that are already hired and that are
planned under the HSS grant. The additional suggested staff for Rd 10 are for new activities and scale
up of existing ones, hence there will be no duplication of staff. All trainings included in Rd 10 are
specifically focused on those staff that need refresher trainings and those staff that will be newly
recruited.
1.6.1 Recruit and retain key NTP programme staff
This proposal seeks to maintain all existing NTCP staff positions currently funded through the round 8
grant. This means that round 10 funding will pay the salaries of existing staff in the 5th year of the
consolidated workplan when Round 8 funding ends. Specifically, Round 10 funding will be used to
recruit additional human resource which are critical to the successful implementation of the
programme: 1 ACSM Expert at National NTCP level, Six (6) additional technologists for the NRL and the
4 Regional Hospital labs in view of new laboratories to be established and introduction of molecular
tests (Line probe assay) for rapid MDR-TB identification; 12 Microscopists to be recruited for the 12 labs
to be established through Round 8 HSS grant; Five (5) phlebotomists will also be hired to man the
additional 5 vehicles needed for the expansion of the sample transport system; 8 Medical Officers and
12 Nurses for the (4) Regional MDR-TB Clinical teams will be constituted to ensure effective
management of MDR-TB. Furthermore, 20 additional DOTS Adherence Officers will be recruited and 67
Expert Clients recruited to assist TB clinic nurse.
1.6.2 Conduct training on various aspects of TB Control

All additional staff needs to be trained and all existing staff needs to routinely re-trained in refresher
trainings especially on the new National TB Programme guidelines due for review. In addition, the
involved CBOs and NGOs need to be trained before commencing their work under Round 10. The
various trainings include: trainings of laboratory staff, trainings for TB treatment (HCWs, adherence
officers, expert clients); trainings for TB/HIV (HCWs on infection control, IPT, ICF, IMAI); training for
prisons staff; trainings on MDR-TB for clinical staff, HCWs, MDR-TB treatment supporters, pharmacists,
and ACSM-related trainings in TB and gender-specific issues for CBOs/NGOs, NTCP staff, journalists,
school health teams, HCWs. Nutrition and gender specific issues will be mainstreamed into all
trainings. Round 10 funding will be used to top up the training budgets in view of the increased
numbers of staff to be trained, which is in turn in line with the decentralization plan.
SDA 1.7 Technical and Management Assistance

Implementer: WHO, URC, CDC/PEPFAR, KNCV, MSF, GLC, others
Target population: NTCP staff, STB Partnership, CBOs/NGOs
Changes in implementation: none, all partners have been and will be active in supporting the NTCP
Link to Rd 8, HSS: Rd 8 and HSS barely included technical assistance, only for a situational analysis in
prisons in year 1.The HSS grant only includes technical assistance to develop at MOH an M&E strategic
plan for the private sector.
Duplication: none. The NTCP coordinates its partners in quarterly partner coordination meetings and
all partners were involved in developing the national strategic plan.
Activities: The NTCP will require extensive technical assistance, mainly for the following areas:
planning and implementation of TB prevalence survey, Drug resistance survey and Operational research
projects; external program reviews; MDR-TB decentralization, Infection Control, ACSM/CSS/gender,
Round 10 implementation, implementation of prisons program, M&E revision of recording and reporting
tools; strategic and annual planning.
Objective 2: Address TB/HIV

SDA 2.1 TB/HIV collaborative activities
Implementer: NTCP, SNAP, ART program
Target population: PLWHA, TB suspects, ART patients, smear negative & EP TB patients
Indicators:
 % of TB patients tested for HIV
 % of HIV+ TB patients initiated on ART
 % of HIV+ patients without TB started on IPT
This SDA focuses on implementing activities to reduce the burden of HIV among TB patients (especially
HIV testing and provision of ART); and decentralization of integrated TB/HIV care as envisioned by the
MOH by strengthening collaboration. This also includes integrating TB-related services (TB screening
and IPT) and HIV-related services (HIV testing and counseling, provision of Cotrimoxazole and ART)
within antenatal services. The programme will scale up intensified TB case finding, Infection control
and strengthening diagnosis of smear negative and childhood TB.
Changes in implementation: It is a new policy of MOH to decentralize and integrate ART into TB
clinics.
Link to Rd 8: HSS: see description
Duplication: Under the World Bank agreement with the MOH, digital x-ray machines will be procured
for all diagnostic sites. The additional ones requested in Round 10 are for non-government facilities
that don’t have an xray machine to diagnose smear negative TB but which are high-volume facilities.
They will be linked to the network that will be established with World Bank support.
Indicators: #(%) of HIV+ TB patients initiated on ART; #(%) of new TB patients screened for HIV
2.1.1 Strengthen TB/HIV collaboration at regional level
This will be in the form of supporting meeting of TB/HIV programme staff at regional level with
representatives of key health facilities on a quarterly basis to promote joint planning, review of
progress and discuss challenges in implementing collaborative activities at that level. This is an entirely
new activity for round 10 funding.
2.1.2 Scale up provision of ART in TB Clinics
For the joint expansion of ART to existing TB diagnostic sites, furniture, IC measures and trainings are
needed to enable a one-stop-shop TB/HIV service policy. Related to this activity, additional lay HTC
counselors will be needed; 67 lay counselors will phased in according to the speed of decentralization
of services (2-3 counselors per facility initiating ART). This is also a new activity for round 10 funding.
2.1.3 Develop integrated TB/HIV co-management curriculum
This proposal seeks to support the development of integrated TB/HIV curriculum for a 5 days
comprehensive training for Medical Officers and nurses as the current curriculum address mainly the
needs of junior cadre of health staff. This curriculum will be used jointly by the TB and HIV and AIDS
programme to conduct joint trainings which will see the discontinuation of separate training by both
programmes for the same target groups. A consultant to be sourced from within the sub-region will be
contracted for this task, after which a stakeholders meeting will be held to adopt the curriculum.
2.1.4 Enhance systematic TB screening among high risk groups:
This proposal aims for a massive scale up of the systematic TB screening among high risk groups
initiated by the WHO/CIDA intensified TB case finding initiative as well as PEPFAR/URC support for ICF
and IPT in Swaziland. As mentioned in SDA 1.6.1, 20 additional Cough Officers are needed for TB
diagnostic sites for triaging of coughing suspects and to conduct ICF among PLHIV at ART sites. Health
care staff working in ART sites, Antenatal clinics and PMTCT sites will be trained on intensified TB case
finding; and TB screening tool will be printed and provided to all sites.
2.1.5 Strengthen diagnosis of smear negative TB and TB in Children
This proposal will enable three (3) private facilities with high volume of HIV positive clients to
strengthen the diagnosis of smear negative TB and Childhood disease through radiography. Three (3)
digital X-ray machines will be procured and supplied to AMICALL, GSH and Baylor Hospitals who are
currently in need of this equipment for diagnosis of smear negative and childhood TB. At the moment,
these facilities face significant challenges in diagnosing smear negative and EP TB, as World Bank is
supporting the installment of these facilities in 4 public facilities and none of the private ones. Hence,
there is an under-diagnosis of smear-negative TB in Swaziland (see epidemiology section). Initially
budgeted under round 8 but could not be realized due to budget cut (cost-efficiency savings), and will
now be for Round 10 funding in the consolidated workplan.
2.1.6 Procure Cotrimoxazole for co-infected TB patients
The NTCP also needs to procure a buffer stock of Cotrimoxazole for TB patients to cover the gaps in
supply from MOH to avoid shortages at all costs. HIV test kits will continue to be provided by the
Swaziland national HIV/AIDS Programme. This is a new activity for round 10 funding.
SDA 2.2 Infection Control

Implementer: NTCP, MOH, facilities
Target population: TB and MDR-TB suspects and patients, PLWHA, HCWs, health care seekers
Indicators: Ratio of TB notification rate (all forms) in health care staff (all staff) over the TB
notification rate in general population adjusted for age & sex.
Activities under this SDA are aimed at instituting Infection control principles and practices in all health
care settings and other high risk environments.
Changes in implementation: none, these are new activities
Duplication: PEPFAR through PATH supported an initial infection control assessment in 14 sites which
provided an overview of IC practices in the health care settings and the World Bank plans to support a
detailed facility specific assessment to determine specific infrastructural adjustments needed to be
addressed. IC specifically for TB is not included in any other disease or GF grant.
2.2.1 Facilitate development of Health facility Infection Control Plans

This proposal will compliment what has already been done in the area of infection control. ToTs have
been done for health care workers from various facilities, but extra trainings are needed so that
facilities are supported to develop and implement their own IC plans to strengthen implementation of
Infection control measures. Round 10 funding is required to support facilities to implement
administrative and personal protection measure including simple environmental controls (e.g
optimization of natural ventilation). This is linked to the international training of Health facility
infection control focal points currently supported by Round 8 grant, and to be continued by R10
funding.
2.2.2 Procure and install prefabricated TB clinics in high volume hospitals
In 5 diagnostic centers, the existing OPD structures do not provide enough space to manage TB patients
separately, therefore extra prefabricated clinics for places where the IC situation is not good to treat
TB will be needed.
This approach was used to address similar situation in 5
other facilities with support from USAID TB/HIV care
improvement programme implemented by URC with good
results. This is an entirely new activity for round 10 funding.
To the left is a picture of one of the prefab clinics installed
at a regional hospital.
2.2.3 Procure personal protection devices

Round 10 support will continue procurement of N95 respirators for HCWs and surgical masks for
patients currently being procured by through the Round 8 grant. However, given the expected increase
in usage, round 10 funding will to up the R8 budget for these items. The quantification will be based on
the expected usage of these masks considering the number of MDR/XDR-TB management units and staff
involved. Furthermore, this will be supported by appropriate fit testing and education of staff on the
appropriate use of the masks.
SDA 2.3 High Risk Groups

Implementer: NTCP, MOH, MOI, correctional services
Target population: prison staff, incarcerated people and those in detention centres, respective
ministries and correctional services
Indicators: Number or % of new smear-positive TB patients reported in prisons among the total
number of prisoners.
The foundation for TB control in high risk groups particularly the correctional facilities has been
established. While an initial assessment of TB/HIV in prisons has been done in collaboration with
PEPFAR/UNODC, a prison program needs to be still implemented. This proposal will strengthen
collaboration between all stakeholders (ministries of health, justice, home affairs, correctional
service, UN agencies, PEPFAR, Local NGOs and prison authorities) to develop an implementation
strategy. This forms the activities under this SDA.
Link to Rd 8, HSS: Rd 8 only included a prisons situation assessment and trainings on high risk groups
which are implemented in year 1 (see TB/HIV section).
Duplication: none, because everything is done in close collaboration with HIV program, UN and other
partners. Other GF disease grants do not include prison program activities.
2.3.1 Strengthen collaboration with Correctional facilities
Round 10 will complement the capacity building trainings for staff of correctional services to ensure
systematic TB screening and provision of TB treatment beyond period of round 8 support in the
consolidated workplan. Consultative meetings will be held on a regular basis between the National TB
Programme, the Swaziland Stop TB Partnership, the Correctional services officials and other
stakeholders in humanitarian assistance e.g Swaziland Red Cross, MSF and local NGOs. These meetings
will be held at least twice annually.
Objective 3: Prevention and Management of drug resistant TB
SDA 3.1 Drug resistant TB treatment

Implementer: NTCP, MSF, URC, WHO/GLC
Target population: DR-TB patients, NTCP staff and HCWs
Indicators:
# (%) of laboratory confirmed MDR-TB patients per year as a proportion of the estimated MDR-TB
patients per year
# Laboratory-confirmed MDR-TB patients enrolled on second-line anti-TB treatment
# MDR-TB patients receiving nutritional support
# MDR-TB patients supported on treatment by MDR-TB treatment supporters throughout treatment
Activities under this SDA are mainly to meet the gap in the annual number of MDR-TB patients to be
treated against the backdrop of the current higher MDR-TB rate than previously anticipated (7.7% in
new cases). Additional second line drugs will be needed than originally forecasted to match the current
rate of enrollment. Currently about 271 MDR-TB patients are enrolled on treatment, but an estimated
560 MDR-TB and 6 XDR-TB are already confirmed. The proposal seeks to treat 4,969 MDR-TB cases
during the 5 years period.
Changes in implementation: MDR-TB treatment was previously centralized at the TB hospital. This
proposal supports the decentralization of MDR-TB treatment to allow for a higher number of (already
diagnosed) patients treated in a patient-friendly manner, i.e. close to home.
Duplication: none.
3.1.1 Procure second line anti-TB drugs
The NTCP currently has second line drugs for a GLC approved cohort of 50 patients under fast track.
MSF has been providing treatment for patients in the Shiselweni region and have received GLC approval
for a cohort of 300 patients for the Shiselweni region which carries the highest burden in the country.
Based on the current MDR rate in the country, a total estimated 6,222 MDR-TB patients (including
Shiselweni as MSF will only support cost of second line drugs in 2010 only) are to be treated over the 5
years R10 proposal period based on the current epidemiology (see table).
New Cases Previously treated cases Total estimated MDR Number
Estimated for which
Estimated MDR cases Projected second
MDR‐TB based on number to be line
Year cases 33.9% prev Total treated treatment Number for
based on Number among projected assuming 80% provided second line
Number 7.7% prev previously previously number of diagnosed by for under treatment
New PTB+ among treated TB treated MDR‐TB the R8 TB under round
cases new cases cases cases cases programme grant 10 grant
2010 baseline 3,953 304 1,651 560 864 691
2011 4,467 344 1,849 627 971 777 75 702
2012 5,047 389 2,071 702 1,091 873 125 748
2013 5,703 439 2,319 786 1,225 980 138 842
2014 6,445 496 2,598 881 1,377 1,101 150 951
2015 7,283 561 2,909 986 1,547 1,238 ‐ 1,238
TOTAL 5 years 32,897 2,229 11,746 3,982 6,211 4,969 488 4,481
Of the estimated 4,969 MDR-TB cases to be detected by the programme during the proposal period,
round 8 grant provides for a total of 488, and 4,481 proposed to be funded through round 10 funding.
3.1.2 Payment of annual GLC cost-sharing contribution:
Round 10 funding will continue meeting the annual GLC operations costs cost-sharing in the 5th year of
the consolidated workplan when round 8 funding ends.
3.1.3 Procure drugs for management of adverse effects:
Management of side effects of second line drugs and potential adverse effects forms an essential part
the management of MDR-TB patients. This proposal will continue procurement of Drugs for adverse
effects currently provided through the Round 8 with an increase in scope due to the estimated increase
in patient enrollments.
3.1.4 Hold monthly meeting of MDR/XDR-TB clinical expert committee (Consillium)
Monthly meetings of Swaziland MDR/XDR-TB Expert Consilium will be supported as a new activity to be
supported by Round 10 funding. The consilium discusses individual patients and shares experiences,
which differs from the MDR-TB working group which discusses and decides on programmatic issues.
3.1.5 Procure basic equipment for management of complications of second line treatment
The TB hospital currently is not equipped with an Audiometry unit, nor with a renal unit, therefore
equipment, training and personnel are needed for both units.
3.1.6 Rehabilitate TB wards in regional TB facilities for management of MDR-TB patients
For the decentralization of MDR-TB treatment to regions, isolation rooms will be renovated to create
admission space in two locations with high number of MDR-TB patients namely I-Care private clinics (10
rooms) and RFM mission hospital (6 rooms). The ventilation system will be installed and need to be
maintained. This was budgeted under Round 8 but funds sufficient only for one (1) centre. Round 10
will fill in the gap for the remaining 3 centres in the consolidated workplan.
SDA 3.2 MDR-TB treatment support and follow up

Implementer: NTCP/TB Hospital, MSF, URC
Target population: DR-TB patients
Indicators: Number (%) of MDR-TB patients supported by a dedicated trained DR-TB treatment
supporter.
Changes in implementation: none, this is a new SDA
Duplication: none
3.2.1 Recruit and remunerate MDR-TB treatment supporters
For each MDR-TB patient enrolled on treatment, a dedicated treatment supporter will be identified
and trained to provide adherence support, assist in ensuring DOT as well as observing for development
of side effects and adverse reactions. The MDR-TB treatment supporters will also accompany patients
on monthly clinical review at follow up at the regional Hospital or national TB Hospital. This proposal
will provide funding for monthly remuneration of the treatment supporters as well as provision funds
for transportation of both patient and treatment supporter for monthly follow up. Funding available
for 100 treatment supporters in the round 8 grant. Round 10 funding will top up the budget for
incentives for additional treatment supporters based on projected enrollment from year 1 to 4; and
take over the entire remuneration of all MDR-TB treatment supporters including the 100 of Round 8 in
the 5th year of the grant.
3.2.2 Provide socioeconomic & nutritional assistance to MDR-TB patients
Because treatment of DR-TB is very long and requires chronic care, DR-TB patients will be supported to
increase the chance of successful treatment and to avoid a spiral into poverty for patients. Therefore,
procurement and distribution of food parcels, as well as transport assistance to DR-TB patients and
treatment supporters for review appointments are planned, as most DR-TB patients are of low
socioeconomic status and lack transport money while transport costs remain a major barrier to TB
care. A psychologist that will provide psychosocial support to DR-TB patients will be requested from
the ministry to be based at the National TB Hospital, and can join the regional teams on need-basis.
This represents an increase in scale over the round 8 budget for this activity. Therefore Round 10 will
cover the gap from year 1-4 and cater for the total requirements in the 5th year of the consolidated
workplan.
Objective 4: Empower people with TB, and communities

This is a new objective for round 10 funding in the consolidated workplan.
SDA 4.1 Advocacy, Communication and Social Mobilization (ACSM)

Implementer: Swaziland Stop TB Partnership, NTCP
Target population: HCWs, community leaders (church leaders, chiefs), journalists & officials, general
population, TB patients, school children and teachers, youth & university students, the disabled,
parliamentarians, editorial board members
Indicators: Population with correct knowledge about TB (mode of transmission, symptoms, treatment
and curability)
Link to Rd 8, HSS: Round 8 only included training for journalists on TB which was already implemented
in year 1 of the grant (before WTB day).
Duplication: none, there are no activities yet by the NTCP on ACSM and partners will be involved in the
development of the materials, so that all materials are harmonized and no duplication will happen.
4.1.1 Strengthen national capacity for ACSM
Until now, the NTCP did not obtain any resources to address ACSM activities. Therefore this proposal
includes on purpose a large section on ACSM activities which are based on the NTCP’s ACSM and CSS
strategy. Firstly, the NTCP wants to strengthen the national capacity for ACSM planning and
implementation by supporting the Health Promotion Unit of the four Regions and the national health
Promotion unit at MOH; the NTCP will need to hire an ACSM expert, as there is currently no expertise
within the program.
4.1.2 Develop/revise TB, TB/HIV and MDR-TB Advocacy and IEC materials
A comprehensive review of the current TB, TB/HIV and MDR-TB IEC materials as well as development of
new ones will be undertaken involving all stakeholders (NTCP, NGOs/CBOs, MOH health promotion unit,
media agencies and HCWs/RHMs) to meet the communication needs of the diverse target groups
(HCWs, community leaders, journalists and officials, general population, TB patients, school children
and teachers, youth & university students, the disabled); and to ensure appropriateness of content,
quality of materials and maximum effect. To achieve this, material development working group
meetings are planned to come up with the concepts, after which a Communication agency will be hired
for final development and editing of IEC materials. All materials will be translated into Siswati by
contracting a Communication agency for translation.
4.1.3 Conduct advocacy meetings with Parliamentarians
To increase government commitment, an annual meeting with the parliament health portfolio
committee is planned to present progress in TB control in Swaziland and remaining gaps; In 2013, a
new elected parliament will be constituted, which needs to be sensitized on TB.
4.1.4 Hold orientation meetings with media practitioners
This proposal seeks to strengthen the collaboration between the Stop TB community in Swaziland and
the media to enhance the quality of TB reportage in terms of factual presentation and regularity of
coverage of TB in the media. Every year at least 20 Journalists will be oriented on current TB situation,
progress and challenges; and at least one half-day meeting will be held with the top editors to discuss
issues of TB and media reportage. These meetings will be jointly facilitated by the Swaziland Stop TB
Partnership and the NTCP. Round 10 consolidated workplan will ensure continuity of this activity which
is currently supported through R8 with a slight increase in scope to include the briefing meetings with
editors.
4.1.5 Broadcast TB, TB/HIV and MDR-TB messages on mass media
TB IEC messages will be broadcasted also in mass media (Swazi Radio and Television) throughout the
year once a week; the same will be done through print media (Swazi newspapers and magazines).
4.1.6 Commemorate World TB Day
World TB Day will be commemorated every 24th of March annually to raise awareness about TB, present
progress and sensitize public on actions to Stop TB. This will include the active involvement of the high
level of the Ministry of Health and partners. The events will be organized at national and regional
levels and to take place at communities nearer to encourage active participation of community leaders
and local CBOs. The costs involved include costs of promotional materials, IEC materials (Posters,
banners etc) and light refreshments.
4.1.7 Conduct School-based TB, TB/HIV campaigns
The Schools Health Programme will be supported to conduct school-based campaigns on TB, TB/HIV
and MDR-TB to educate children on the basic facts about TB and prevention. This is in view if the
available evidence of how children can influence health seeking behavior at their homes when
adequately educated on a health issue like TB. This activity will be conducted on a continual basis as
part of normal schedule of the Schools programme. The costs to be met by the Round 10 grant include
cost of promotional materials for school campaigns, and lunch allowances for the team members.
SDA 4.2 Stop TB Partnering initiatives at country level: Strengthening and maintenance of the
Swaziland Stop TB Partnership
Implementer: Swaziland Stop TB Partnership, NTCP
Target Population: all CBO, FBO and NGOs that work on TB/HIV in Swaziland, STBP, program partners
Changes in Implementation: The Stop TB Partnership is currently housed in the NTCP but will need
additional rooms in the future for the new staff.
Link to Rd 8, HSS: Rd 8 included the administration overhead for the NTCP for the Partnership as well
as the Partnership Secretary and officer. Both will continue their work. Also, the orientation of SRs by
PR NERCHA has been included in Rd 8 year 1, but will need to be repeated for Rd 10.
Duplication: none.
4.2.1 Strengthen capacity of the Swaziland Stop TB Partnership
This proposal; will strengthen the existing human resource capacity of the Partnership by recruiting a
higher level executive director of Stop TB Partnership Secretariat, a finance officer, Communications
Officer, Capacity Building Officer and an M&E Officer. In addition, administrative support to the
partnership is needed (i.e. Computers); Office rent for the Stop TB Partnership office
4.2.2 Hold Partnership coordination and supervisory activities
The consolidated Round 10 proposal will strengthen the coordination role of the Swaziland Stop TB
Partnership by supporting holding of its biannual coordinating board meetings, annual partnership
members general assembly and fund raising forum; as well as specific technical working group
meetings (5 working groups that already exist: TB/HIV, MDR-TB, laboratory, M&E, ACSM). At least two
Partnership community members will participate in the Union conference to meet with other national
partnership delegates and exchange knowledge and best practices and for networking purposes.
SDA 4.3 CSS: Human resources: skills building for service delivery, advocacy and leadership
Implementer: SR NTCP, CBOs/NGOs through SR STBP
Target population: HCWs, community leaders (church leaders, chiefs, healers), officials, CBOs, general
population, TB patients
Indicator:
 Number of CBOs participating in community-based TB program activities and submitting
reports to the NTP and Stop TB Partnership.
 Number (%) of Community leaders participating in social mobilization activities for TB in the
communities.
Changes in Implementation: So far, GSH was the only SR for CB-activities; The STB Partnership will be
the second one; GSH will continue to be SR for patient-support activities and this role will be expanded
to new activities, while the Partnership will be SR for ACSM and community mobilization and education
activities.
Link to Rd 8, HSS: this is a new SDA
Duplication: none, all CBOs/NGOs capacities have been assessed in the Rd 8 proposal development
process and they will be coordinated by the respective sub-recipients.
4.3.1 Orient Community leaders on TB
To strengthen community linkages to address TB, various Community leaders will be sensitized through
this proposal. The activities targeting target community leaders include: Sensitization of the traditional
Chiefs who head each of the 369 chiefdoms in the country; collaboration with the church forum leaders
to sensitize 200 church leaders per year on TB symptoms, treatment and prevention (2 meetings per
year), training of heads of maidens from the 369 Chiefdoms, and traditional healers. As a key
component of the community system, the RHMs programme leaders will also be engaged to orient at
least 600 members per year on community-based TB care.
4.3.2 Build capacity of local CBOs to conduct community-based TB campaigns, patient literacy and
screening:
The proposal also seeks to build capacity of CBO/NGOs through training and regular supervision support
from the Swaziland Stop TB Partnership Capacity Building Officer to conduct community sensitization
and awareness campaign activities about TB and TB/HIV, including door-to-door campaign. The Stop TB
Partnership will be responsible for contracting these organizations and assigning specific tasks in an
agreed area of operation, and accountability of performance.
SDA 4.4 CSS: Community based activities and services - delivery, use and quality
Implementer: SR STBP, SR GSH, CBOs/NGOs/FBOs, The Luke’s Commission
Target Population: TB suspects and patients, support groups, PLWHA, HCWs
Indicators: New smear positive TB patients referred by the community among the new smear positive
TB patients reported to the national health authority (started on treatment in NTP) (number and
percentage)
Changes in implementation: none, this is new.
Link to Rd 8, HSS: none, this is new
Duplication: none, see above
4.4.1 Conduct community-based TB campaigns, patient literacy and TB screening activities
NGOs and CBOs have been contracted under Rd 8 through SR GSH to conduct training of Community
treatment supporters (RHMs) on adherence, TB suspects identification, sputum collection, IC; this
activity will be expanded to involve three (3) additional CBOs/NGOs. The same CBOs will be further
supported to conduct community level TB screening and suspect referrals. In addition, other CBOs will
be contracted to conduct patient education (treatment literacy package) mainly through existing HIV
and TB patient support groups that these organizations are linked up with.
4.4.2 Adapt and disseminate Patients charter
To strengthen patients’ rights, a workshop with NTCP, partners and NGOs will be held to introduce and
adapt the Patients’ Charter to Swaziland; afterwards it will be translated into Siswati, printed and
launched in an official event. A partnership will be established jointly with the HIV and Malaria
program with mobile network providers for a toll-free line for patient support for TB, HIV, Malaria
patients.
(b) Changes to existing SDAs, programmatic activities, indicators and targets
In the table below, list the SDAs and activities of existing grants consolidated within the Round 10
consolidated disease proposal. Explain whether each SDA and activity from an existing grant will be
included in the Round 10 consolidated disease proposal by indicating an increase in scale, decrease in
scale, continuation without change, or discontinuation. Provide justification for any proposed changes
or discontinuation.
 The proposed changes should be clearly and systematically reflected in the Consolidated Performance
Framework
Round Service Delivery

Activity Proposed change Justification for change
Area (SDA)
Patient Incentive fund for Increase in scale. 3 additional CBOs to be
R8 Support treatment support To be included engaged through Round 10 to
to community under objective 2 increase coverage of
based organizations high quality DOTS. community-based support.
Improving Procure sputum Discontinued To be procured through
R8 diagnosis containers Government regular budget
Improving Procure 6 LED increase in scale 3 additional centres to be
R8 diagnosis microscopy units equipped with LED
microscopes
Improving Procure binocular increase in scale 6 additional binocular
R8 diagnosis microscopes to microscopes needed to equip
replace old ones new rural labs.
Improving Procure Reagents Procure only in the Partners (FIND) to procure
R8 diagnosis and consumables last three years of from 2010-2012
for liquid culture grant
Improving Procure and install increase in scale 8 labs will require new or
R8 diagnosis Biosafety cabinets replacement of cabinets in
class for the NRL the next 5 years. R8 phase 1
funding lost to 10% cost-
efficiency savings.
Improving Maintenance for increase in scale R8 funding provided for
R8 diagnosis Biosafety cabinets maintenance of 1 Biosafety
including filters cabinet. A total of 9 cabinets
need to be maintained in the
next 5 years.
Improving Process 2nd line increase in scale Increased numbers of MDR-TB
R8 diagnosis DST for XDR-TB patients to be enrolled
suspects at SNRL annually over those
estimated in R8. Also R10
funding needed for this
activity in Year 5 of the
consolidated workplan.
Improving Procure Reagents increase in scale Increase in the estimated
R8 diagnosis for 300 PCR based number of patients to
probes(Gen probe) receive molecular tests over
of non TB those estimated in R8.
mycobacteria TB
per year
Improving Provide Discontinuation National Sample
R8 diagnosis transportation transportation system will
rechecking slides take over transportation of
using Courier for slides for QA.
samples from
diagnostic TB units
to NRL
Area (SDA)
Improving Develop scheme Increase in scale 12 additional peripheral
R8 diagnosis for proficiency laboratories to be included in
testing between a the national TB lab network
NRL and a during proposal period.
Supranational
Reference
Laboratory (SRL)
and Provide for SRL
monitoring visits
for laboratory EQA,
culture and DST
Improving Transportation of Continuation R10 funding only required in
R8 diagnosis panels from SNRL without increase in Year 5 of the consolidated
(MRC Pretoria) to scale workplan.
NRL.
Patient Provide Transport Discontinuation Difficult and complicated
R8 Support vouchers for TB disbursement mechanism;
patients on first CBOs engaged to support
line treatment for patients instead.
clinical and
laboratory follow
up at diagnostic
sites(2, 5/7 months
and end of
treatment
Patient Provide food Increase in scale Increased number of MDR-TB
R8 Support packages for patients to be enrolled on
MDRTB second line treatment
patients(Scaled up annually;
up to 150 patients)
Patient Provide Transport Increase in scale Increased number of MDR-TB
R8 Support vouchers for patients to be enrolled on
MDRTB patients second line treatment
annually;
Programme Procure 15 Increase in scale 15 additional Adherence
R8 management motorbikes for Officers/Defaulter tracers
and sputum transfers , required to cover additional
Administration community drug TB treatment initiation sites
cost delivery and to be established.
defaulter
tracing(each TB
diagnostic site)
Programme 8 vehicles Increase in scale Decentralization of MDR-TB
R8 management care provision and
and supervision to regions; and
Administration laboratory QA visits. 6
cost vehicles for MDR-TB
supervision (2 Central level,
and 4 vehicles i.e 1 per
region); and 1 Laboratory
supervision.
Programme Office space, Continuation R10 funding only for this
R8 management Supplies and without increase in activity in year 5 of the
and equipment at scale consolidated workplan.
Administration national level
cost (NTP, NRL, STOP
TB)
Area (SDA)
Programme Renovations for Increase in scale Current funding will be
R8 management NTCP offices: Rent insufficient to accommodate
and new Focal points; and
Administration successfully host the Stop TB
cost Partnership.
Programme Renovation of Discontinuation Government will renovate
R8 management offices for Regional the offices.
and Coordinators
Administration
cost
Programme Building capacity of Continuation with
R8 management the SR increase in scale
and
Administration
cost
Programme PR overheads Continuation with
R8 management increase in scale
and
Administration
cost
ACSM Salary secretary for Continuation
R8 (Advocacy, Secretarial support without increase in
communication to the Swazi STOP scale
and social TB partnership
mobilization)
ACSM Salary Coordinator Continuation
R8 (Advocacy, for Secretarial without increase in
communication support to the scale
and social Swazi STOP TB
mobilization) partnership
MDR-TB Salary for Continuation
R8 Pharmacist for the without increase in
Central level-NTP scale
M&E Salary for an NTP Continuation
R8 M&E officer without increase in
scale
MDR-TB Salary for Deputy Continuation
R8 Programme without increase in
Manager for the scale
NTP
M&E Salary for Finance Continuation
R8 officer for the NTP without increase in
scale
M&E Salary for the Discontinuation Already funded by another
R8 Quality Assurance partner
Officer for the
national Referral
lab to coordinate
lab QA
Improving Salary for Continuation
R8 diagnosis Microscopists the without increase in
national Referral scale
lab
Improving Salary for Continuation
R8 diagnosis Technologist the without increase in
national Referral scale
lab
Area (SDA)
Programme Salary for Continuation
R8 management M&E/Finance without increase in
and officers for the NTP scale
Administration for PR and Sub-
cost recipient
M&E Salary for Regional Continuation
R8 Coordinators without increase in
scale
TB/HIV Salary of cough Increase in scale 20 additional Cough monitors
R8 monitors in ART required to conduct TB
sites screening in OPDs, Diabetic
clinics and Antenatal clinics
of big hospitals.
Improving Salary for lab Increase in scale 12 additional peripheral labs

R8 diagnosis technologists for to be established during the
peripheral health proposal period. Increase in
facilities number of technologists
required for support to
peripheral labs.
Improving Salary for 6 Increase in scale 12 additional peripheral labs

R8 diagnosis microscopists to to be established during the
support diagnostic proposal period. Increase in
health facilities microscopists needed to man
the newly established
peripheral labs.
High Quality Salary for 15 Increase in scale 36 additional TB treatment

R8 DOTS Default initiation sites to be
tracers/Adherence established. Need for
officers additional
Adherence/Defaulter tracing
Officers.
Patient Salary for 40 Discontinuation Absorbed under MDR-TB
R8 support Community based treatment supporters.
health workers
High Quality Training for Increase in scale Due to increased number of
R8 DOTS adherence officers Adherence Officers to be
to include DOTS, engaged.
adherence
counseling, contact
tracing & drug
distribution
High Quality Training for Increase in scale. In line with increase in the
R8 DOTS diagnostic staff in number of TB diagnostic sites
TB management
Improving Refresher training Continuation R10 funding required only for
R8 diagnosis for 16 technicians without increase in activity in year 5 of
on AFB and scale. consolidated workplan.
External Quality
Assurance
Improving Training for 10 Continuation R10 funding required only for
R8 diagnosis technicians on LED without increase in activity in year 5 of
fluorescent scale. consolidated workplan.
microscopy per
year
Area (SDA)
Improving Train for Continuation
R8 diagnosis technicians on without increase in
culture and DST at scale.
SNRL for 3 weeks
Improving Train 10 Increase in scale 12 additional microscopists
R8 diagnosis microscopists to engaged
High Quality Training for MDR Increase in scale In line with increase in the
R8 DOTS community Health estimated number of MDR-TB
Workers patients to be treated.
High Quality Training of Continuation R10 funding only required for
R8 DOTS community without increase in same activity in year 5
treatment scale.
supporters
ACSM Training journalists Continuation R10 funding only required for
R8 (Advocacy, on TB without increase in same activity in year 5
communication scale.
and social
mobilization)
High Quality IUALTD course Continuation R10 funding only required for
R8 DOTS without increase in same activity in year 5
scale.
High Quality MPH course abroad
R8 DOTS
High Quality Regional TB Continuation R10 funding only required for
R8 DOTS conference without increase in same activity in year 5
scale.
High Quality IUALTD Increase in scale Increase in number of
R8 DOTS International participants to include
conference laboratory staff.
High Quality Infection control Increase in scope To include additional in-
R8 DOTS courses country infection control
facilitators.
HSS: Health Train additional Increase in scale; In line with increase in the
R8 Workforce core staff in Activity to be re- number of TB diagnostic
reading x-rays to assigned under SDA sites, and hence number of
rule-out TB and 2.1 TB/HIV Medical Officers to be
other non-TB trained.
diseases and
diagnose smear-
negative and extra-
pulmonary in
pediatric and
TB/HIV cases
MDR-TB International Increase in scope 4 Regional MDR/XDR-TB
R8 training for Medical clinical teams to be
doctors and HCW established. Hence, increase
involved in MDR-TB in number of clinicians to be
management trained.
High risk Interventions for Continuation R10 funding only required for
R8 groups high risk groups without increase in same activity in year 5
scale.
Technical and Assessment of Discontinuation Will be conducted through
R8 Management human resource KNCV and WHO
Assistance and training needs
of community
Area (SDA)
Technical and Technical Increase in scale Anticipated increased
R8 Management assistance missions programme TA demands in
Assistance MDR-TB, Infection Control,
Community DOTS and ACSM
Operations Cost for conducting Continuation
R8 Research operational without increase in
research on in TB scale.
diagnostic issues
laboratory
Operations Cost effectiveness Continuation
R8 Research study for the without increase in
Swaziland scale.
community DOTS
system
TB/HIV Procure HIV rapid Discontinuation To be procured by the
R8 tests for TB National HIV&AIDS
patients Programme (SNAP)
High risk Situation analysis Discontinuation Currently being undertaken

R8 groups on burden of TB in with support from UNODC
prisons and other
settings to identify
high
risk groups and
determine the
barriers
which prevent
access to TB
control
services
HSS: Service X-ray machines Continuation

R8 delivery without increase in
scope;
Activity to be re-
assigned to SDA
2.1: TB/HIV
Infection N95 respirators for Increase in scope Increased number of MDR-TB
R8 Control HCWs cases to be managed;
increased number of sites
(Regional Hospitals) to be
involved in managing MDR-TB
MDR-TB Procure and Increase in scope Increased number of MDR-TB

R8 distribution of patients to be enrolled on
Second line drugs treatment annually;
from the GLC and
drugs for adverse
effects
MDR-TB Procurement, Increase in scope Increased number of MDR-TB

R8 storage and patients to be enrolled on
distribution of treatment annually;
drugs for adverse
events
Area (SDA)
Community TB Enablers for Increase in scope Increased number of MDR-TB
R8 care community MDR-TB patients to be enrolled on
Treatment treatment annually;
supporters to
manage Default
and contact tracing
and provide patient
support
MDR-TB Cost sharing to GLC Continuation Standard rate of USD50,000
R8 initiative without increase in payable annually. Round 10
scope funding required only for
Year 5 in the consolidated
workplan.
MDR-TB Renovation of 3 Increase in scope Previously budgeted in Year
R8 existing of the 1 of Round 8. However
hospitals to provide grossly under-budgeted.
additional Round 10 funding required to
inpatient isolation top up to meet the current
space 5-10 patients costs.
(c) Changes to existing impact or outcome indicators and targets

Describe any major changes in indicators and targets that may have occurred due to the programming
described above in sections (a) and (b) and that is supported by the Consolidated Performance
Framework. In particular, if there has been discontinuation or change in indicators or if targets have
been changed between previous grants and the Round 10 proposal, describe why this has occurred.
ONE PAGE MAXIMUM

The Programme will sustain the current three impact indicators of Prevalence, incidence and
mortality. However, following recent consultations on the projected impact indicators in the round 8
performance framework, it was concluded that the Round 8 targets which showed a decline in
incidence and prevalence within the next 5 years were not realistic given the approximately 10% rise in
case notifications over the last 5 years. In the development of the consolidated performance
framework, the assumption is for a progressive annual increase in TB prevalence and incidence during
the proposal period rather than a decline. Hence the need for stepwise increment in the targets as
proposed in this application.
With respect to measurement of outcomes, the national TB Programme has adopted the recent WHO
recommendations to use TB Case Notification Rate (CNR) as opposed to the TB Case Detection Rate
(CDR). This is reflected in the current consolidated performance framework.
The following are the specific changes in indicators and targets in the consolidated performance
framework:
i. SDA 1.2: High quality DOTS:
a. Additional indicator: number of # health facilities enrolling and initiating TB patients
on TB treatment. This indicator was added to enable tracking of the decentralization of
TB diagnostic sites to be supported by the round 10 funding.
ii. SDA 2.1 TB/HIV Collaborative activities
a. Additional indicator: # (%) of HIV+ TB patients initiated on ART. This was added in view
of the need track the planned scale up of ART provision to HIV positive TB patients.
iii. SDA 3.1 Prevent and Control MDR-TB
a. Existing round 8 indicator rephrased from # (%) of laboratory confirmed MDR-TB
patients among smear positive TB patients (new and retreatment) as a proportion of
estimated number of MDR-TB patients among smear positive new and retreatment
patients to Number (%) Laboratory-confirmed MDR-TB patients enrolled on second-
line anti-TB treatment as percentage of estimated cases for the period. This is in
view of the need to reflect enrolment of cases.
b. Existing Round 8 indicator rephrased from % of laboratory confirmed MDR-TB patients
enrolled in second-line anti-TB treatment to Percentage of MDR-TB cases initiated
on a second-line anti-TB treatment who have a negative culture at the end of 6
months of treatment. This is in view of the need to track interim results of patient
cohorts after six months of treatment.
iv. SDA 4.1 Advocacy, Communication and Social Mobilization (ACSM)
a. New addition to the PF to track the new objective in the round 10 proposal.
No other round 8 indicator has been completely discontinued except for adjustment of period targets
in line with the current consolidated plan. These targets are reflected in the consolidated PF.
4.4.2 Addressing weaknesses from a previous category 3 proposal

If relevant describe how the weaknesses identified in the TRP Review Form of a previous category 3
proposal have been addressed.
Not applicable – Round 8 was approved.
4.4.3 Lessons learned from implementation experience

How do the implementation plans and activities described in 4.4.1 above draw on lessons learned from
program implementation (from either Global Fund financed or non-Global Fund financed programs)?
The lessons learnt from global fund and other non-global fund implementation can be categorized
into positive and negative lessons.
The positives:
1. The value of a phased implementation approach
The national tuberculosis control partners have appreciated the importance of a phased
scale up approach in the implementation of activities. Experience in this regard has
demonstrated that the phased implementation not only allows quality to be in-built into
the scale up process, but also goes in tandem with the programme capacity and therefore
allows for smooth implementation and monitoring. This is evidenced by the successful scale
up of the collaborative TB/HIV activities in the country. Therefore in planning the round 10
interventions, NTP has maintained a reasonable scope that it can deal with before rapid
expansion to ensure that all suggested activities are achieved. E.g. laboratory expansion
will follow such a gradual scale up to ensure that all the necessary requirements in terms of
staff and equipment are in place before scale up.
2. Technical and Management Assistance
Since 2007, the National TB programme was provided with both resident and external
technical assistance support through WHO, URC and KNCV. The availability of this TA
support has enabled the programme to make considerable progress in the implementation
rate of the past global fund grants, development of programme policies and guidelines and
general programme management and administration. The bold scale up of key interventions
in the round 10 proposal took into consideration the availability of these technical
resources in the country to adequately advise the programme on implementation and scale
up of the MDR-TB programme, integrated TB/HIV and enhancement of quality-DOTS. It also
includes a sustainable technical assistance plan.
3. Advocacy targeting government officials
The Programme has learnt from the implementation of the previous round 3 grant that
consistent engagement of government officials through advocacy yields excellent results.
With Global fund Round 3 support, the programme engaged parliamentarians and other
government officials on TB. This has resulted in Government establishing direct
procurement with the Global TB Drug Facility (GDF) for first line anti-TB drugs, which has
put an end to the hitherto incessant drug shortages. Furthermore, the government having
appreciated the magnitude of the TB problem has officially decided to declare TB as a
national emergency scheduled for the 4th quarter of 2010. This was considered in
articulating the 4th objective of this proposal to intensify Advocacy, Comunication and
Social Mobilization in the country.
4. Human Resources:
The experience of the NTP so far has re-affirmed the critical importance of sufficient
numbers of human resource and rational deployment strategy to successful
implementation. It is evident that since 2006, with assistance from URC then later in 2008
with assistance from WHO, MSF and KNCV, including government postings to NTCP, there
has been progressive capacity building of the NTCP and expansion in terms of quality and
quantity of HR for TB. After a period of centralization and underfunding of the HR
component of the TB control programme, increased funding for HR positions through GF in
recent years has resulted in impressive improvements in TB outcome indicators: TB case
detection rate up from 38 in 2006 to 68 in 2009 and treatment success improving from 42%
in 2006 to 68% in 2009. The increased HR also enable decentralization of TB services to
regional level. In the current grant, the NTP desires to further scale up decentralization
beyond the existing 30 diagnostic units to 67 units. The NTP has rationalized on efficient
and effective ways on how to achieve this in the round 10 activities using these lessons
learnt.
5. Monitoring and Evaluation Systems Strengthening:
During the course of the round 3 grant implementation, the PR, National TB programme and
partners conducted an M&E Systems strengthening self-assessment which revealed the
weaknesses of the TB M&E systems as well as enabled development of action plan to
address the weaknesses. Since the implementation of the M&E strengthening actions, a
considerable improvement has been recorded in the programme M&E systems. These
lessons have been employed in the current round 10 proposal as a means of continuous
strengthening of the M&E system.
The Challenges
The implementation plans for activities in 4.4.1 also draw from lessons learned from challenges
under the following categories:
6. Grant negotiations:
The country has learnt from the past experience of delayed negotiation and
commencement of the round 8 grant, which was occasioned by inadequate preparations,
delayed stakeholder’s consensus etc. We have appreciated the value of time as a critical
factor in scaling up these life saving interventions. In deciding the commencement time of
the round 10 grant, the country at the same time considered putting in place grant
negotiations preparations immediately. The timing proposed in the implementation of the
activities of GF Round 10 have come from our experience of the learning curve, as well
preparatory phases inbuilt in round 3 and round 8 global fund grants.
7. Challenges of mobilizing new grant implementers (Sub-recipients):
Lessons were learnt regarding the mobilization of new Sub-recipients to commence grant
implementation. Mobilization of Good Shepherd Hospital as SR for the existing Round 8
grant became protracted due to delayed starting of the process. The implementation
arrangement outlined for this grant has incorporated immediate capacity building for the
proposed SRs and other community-based implementers. The PR will be proactive in
starting the process of development of revised work plans, PSM plans, sub-grant agreement
documents and LFA assessments for the new SR in a timely manner.
8. Challenges with remuneration of community-based workers:
There exist many forms of community based workers within the country with different
remuneration packages and different scopes. This creates unhealthy competition. In
addition, basis for remuneration can become a challenge whether based on number of
patients supported or quality of service delivered/ outcome on patient. The experience of
the existing round 8 grant revealed another innovative way of ensuring patient follow up
through local CBOs, which will be continued in the round 10 consolidated proposal.
9. Recruitment of Health Care staff:
Low budgets for staff packages in the round 8 GF grant have affected recruitment of key
staff like the MDR-TB doctor. In this proposal, we have learned from the past and are
proposing commensurate packages. Furthermore, we have learnt to use government salary
rates to avoid gross disparity among staff members.
4.4.4 Enhancing TB/HIV collaborative activities
Describe:
(a) how the proposal will contribute to strengthening TB/HIV collaborative activities; and
(b) the collaboration between the National TB program and the HIV services of your country.
Coordination
The NTCP with support from partners has made great progress in scaling up implementation of TB/HIV
collaborative activities since the WHO program review in 2007. A national TB/HIV coordinating
committee (NCC) co-chaired by SNAP and NCTP was formed in 2007 and TB/HIV Policy guidelines
developed. The NCC meets quarterly and both the NTCP and SNAP has a TB/HIV focal person.
Communication and cooperation between NTCP and SNAP is proactive and regular. The committee
however needs to be expanded because of new implementing partners who will be invited to join. The
proposal will support monitoring and evaluation activities of the National Coordinating Committee. In
addition, regional activities have started with TB/HIV coordination committee meetings being held in
Shiselweni with assistance of MSF providing a good example for the other regions. With Support from
URC, Regional TB/HIV committees were recently formed for Hhohho and Manzini Regions in July 2010.
Facility-level HIV/TB committees have been initiated at several sites. ART registers were updated and
now include a section on TB screening which was piloted and will be rolled out in all settings. This
proposal will supports TB/HIV regional committees in all four regions to conduct joint planning,
resource mobilization and monitoring of TB/HIV activities, support implementation of the three “I”s
including pre-service and in-service a joint curriculum development for nurses and RHMs and trainings
on infection control, IPT and intensified case finding; TB screening tool developed and agreed upon and
has been rolled out in about 10 ART sites.
Services
Progress can be seen in HIV testing and counseling with 71% of all notified TB cases tested for HIV in
2009 (59% in 2008), of which 83,7% were positive; and 95% of all HIV+ TB patients on CPT. All TB
suspects and patients are offered HIV testing and counseling, some TB clinics also do CD4 counts and
refer then directly to the ART center. HIV testing supplies are provided through NRL. No stock-outs of
HIV testing supplies were reported in 2008, however there were shortages of Cotrimoxazole in TB
clinics. Currently, several clinics offer completely integrated care (one-stop-shop). At most clinics food
packages and condoms are offered. Where there was not enough space available for HTC and through
the support of URC mobile clinics were installed at Mbabane Government hospital, Hlatikhulu Hospital,
Piggs Peak Hospital, Mkhuzweni Health Centre and RFM hospital and five more prefabricated TB clinics
are planned in this proposal (see infection control). HIV/TB outreach activities are conducted by grass-
roots organization that provide home based care, IEC, VCT, suspect referral services. In April 2010, the
HIV, ART and TB programs jointly decided to roll out ART to TB clinics in the coming years (there are
currently a total of 21 ART centers in Swaziland). The NCC has established an IPT working group and
decided to pilot IPT in 2009. IPT is now provided in approximately 15 facilities and will be rolled-out
after the evaluation of the pilot which is part of this proposal. Accreditation criteria for facilities and
recording & reporting tools were developed by the team, and nurses were trained. Reprinting the tools
is part of this proposal. In addition, this proposal supports service delivery through additional x-rays to
diagnose sputum smear negative TB as it is common among HIV+ suspect, a buffer stock of
Cotrimoxazole to avoid stock-outs at all costs, and ART will be expanded to all TB diagnostic sites;
Intensified TB Case Finding (ICF)
To start up ICF, PEPFAR through URC supported a pilot project to implementation of systematic TB
screening in PLHIV using a standardized screening tool. This enabled to the tool to be validated and
adopted by the country. The program decided to continue with these screening activities and to expand
with support of the WHO/CIDA initiative which includes systematic TB screening among PLHIV and other
high risk populations including diabetic patients and general OPD. URC printed 40,000 national TB
screening tools to kick start the systematic screening and this proposal will provide for printing of
additional screening tools. On the HIV-side, organizations such as MSF, ICAP and EGPAF screen for TB at
ART and PMTCT clinics. Other potential partners including the Centre for Tuberculosis Research at the
John’s Hopkins University have shown interest in expanding ICF to Antenatal and PMTCT clinics. This
proposal includes additional lay counselors and cough monitors to boost HTC and ICF to expand ICF to
all ART centers and antenatal clinics.
4.4.5 Enhancing social and gender equality
Using specific references to objectives, SDAs, and activities included in section 4.4.1, explain how the
Round 10 interventions address issues related to social and gender equality and confirm that these
items have been properly costed in the budget.
This proposal explains and addresses the underlying causes of gender and social inequalities in
Swaziland in the following way:
1. Equitable access: Urban bias to health care and distribution of human resource for health has been
recognized as a major challenge to access in the country. Access to health care is more difficult for
the rural population than for the urban population due to far distances to facilities and lack of
affordable public transport. Access is particularly constrained for women in Swaziland due to social
and cultural norms. For example, women in Swaziland commonly require the husband’s permission
(and sometimes also in-laws) to seek care. Some might not be allowed to go to the facility by
themselves; If none can be found to care for the children during this time, the woman might opt not
to go. If competing health care demands exist in the family, boys and men are prioritized to girls and
women. If the woman does not have access to family resources, she might not be able to seek health
care. SDA 1.2 on TB treatment and SDA 4.4 on community systems address the issue of hard-to-reach
services by decentralizing TB diagnosis and treatment and involving community based organizations
for TB screening, suspect referral, diagnosis, patient follow-up and health education. Community-
oriented trainings will include gender specific issues on TB and HIV (SDA 4.5 and 4.4). In addition, the
communication and community-based social mobilization activities (SDA 4.2 and 4.2.6) in this
proposal are aimed to inform the population about symptoms of TB and consequences of diagnostic
and treatment delays in order to encourage people to seek care early. On purpose, multidimensional
approaches are employed to address the information needs of all groups in the population: men,
youth, women and children (through schools, community gatherings, CBOs, FBOs, church, chiefs,
radio, TV, youth magazines etc), see SDA 5.2 Increased TB/HIV knowledge among TB patients,
communities and the general public. This proposal also addresses the needs of the disabled by
developing picture-based IEC materials and supporting an NGO (Lulwimi Lwetandla consultants) that
provides assistance to the deaf in seeking health care and treatment support.
2. Prioritized access: this proposal does not specifically seek to prioritize access for a certain group.
However, the NTCP has started and will continue to implement a TB in prisons program where
typically more men are affected by TB and HIV than women (SDA 2.3 High risk groups).
3. Social equality, policy change: As explained above, women in Swaziland are not equal right holders
as their male counterparts. Social norms commonly prevent women to be empowered on sexual
negotiation skills to insist on condom use by their partners or to have a say in family-planning or
breast-feeding. Despite the knowledge of the HIV status of the partner, women cannot always
protect themselves from becoming infected with HIV and then infecting their children. This proposal
therefore supports NGOs and CBOs which are active in the fight against social discriminatory
practices and sexual violence and to strengthen the rights of women and lobby for changes in policy;
(SDA 4.4, 4.5). Furthermore, the NTCP aims to strengthen patient’s rights by adapting and
disseminating the TB patient’s charter (SDA 4.4.8).
4. Stigma and discrimination: Stigma against HIV+ persons is high in Swaziland. Although 30% of the
population is infected, the subject remains a taboo. HIV status is often not shared within the family,
nor the community or friends. This drives the spread of HIV and the incidence of TB. HIV+ people are
at risk of losing their jobs, and likely to be outcasted and no longer tolerated within the family.
Because HIV infection is higher among women in Swaziland, stigma and discrimination particularly
hits hard on them. Women (and men) then often don’t have any source of income and no support
system behind them. This proposal therefore supports NGOs and CBOs that are active in the fight
against stigma and discrimination, work with youth and support women and men to sustain
themselves financially through income generating activities; In addition, boys and girls will be
separately addressed by information campaigns during the annual traditional reed dance ceremonies
(SDAs 4.2, 4.4, 4.5) which usually attracts large numbers of the target group attending.
5. Gender inequalities: as described above, women and girls face inequalities in their daily lives
which affect their health. In addition, female TB patients face additional hurdles which they need to
know about. For example, Streptomycin should not be given to pregnant women due to its potential
to cause teratogenic effects on the foetus; Rifampicin interacts with oral contraceptives which
require women to take additional protection measures. However, often health care workers lack this
information because it is not included in their trainings or they are aware but fail to act on it, for
example by using pregnancy tests for female retreatment patients or providing female TB patients
with female condoms. Therefore, this proposal includes mainstreaming of gender-specific issues in
TB, TB/HIV and MDR-TB trainings; trainings of NTCP staff and NGOs about gender-specific issues in
TB care, and supports an NGO (Women Together) to sensitize support groups and women networks
(verbally and through separate leaflets), see SDAs 4.4 and 4.5.
(Sources: Swaziland NTCP annual report 2009; Demographic and Health Survey Swaziland 2007; Reza et
al: Sexual violence and its health consequences for female children in Swaziland: a cluster survey
study. The Lancet 373 (9679),p.1966-1972, 2009, United Nations Development Assistance Framework
UNDAF complimentary country analysis 2009.)
4.4.6 Partnerships with the private sector

Describe how contributions related to: (i) co-investment from the private sector, and (ii) donated goods
or services, will add value to the planned outcomes of the proposal. Make specific reference to the
associated objectives, SDAs, or activities to which they are linked.
The private sector forms part of the general health care delivery system in the country for TB, HIV,
Malaria and other diseases. Tuberculosis services are provided by the public, mission, and private sector
(both private for profit and private corporate companies). There are national guidelines for TB
management which are followed in all health facilities that provide TB services (private and public).
Currently, 3 private corporate businesses with health facilities, 8 private-for-profit large facilities with
inpatient facilities and 7 small private for profit facilities are providing TB services. In the coming
years, at least 3 more facilities will be engaged. The private sector health facilities involved in TB
management activities receive TB drugs for free from government and provide them for free to private
patients.
In the private for profit health facilities patients only pay the consultation fees. The agreement
between the private sector and government is that the medical insurance of Swaziland excludes
payment for TB drugs because government supplies them, even the local pharmacies no longer stock
anti-TB drugs which means they should be given for free regardless of whether they are managed in
public or private sector. The private corporate companies provide TB services for free as part of their
social corporate social responsibility. The TB Programme provides technical support to these facilities
and supplies them with TB registers, patient’s cards and all the reporting forms through regional TB
coordinators. The coordinators conduct monthly supervisory visits to these facilities. Each diagnostic
site (private or public) has a TB focal person responsible for all TB management services in that facility.
These focal persons meet every quarter to review progress and discuss and analyze data from each
facility and share experience and best practices. Trainings are conducted by the government and its
partners and participants are from both sectors, this is to help standardize TB management in both
sectors. The partnership operates based on a memorandum of understanding (MoU) after a private
health facility has been accredited to provide TB services; accreditation is done through agreement on
the minimum package for that TB service to be provided. NTP provides Adherence officers and Cough
officers to private facilities.
The NTCP is also partnering with the private sector to implement joint work place programmes. In 2008,
NTCP in collaboration with corporate employers in the country developed the national TB Workplace
guidelines, which provide guidance on the various activities that all employers in partnership with
workers can undertake to contribute to TB control and how to carry them out. Most employers will be
able to contribute towards the following key components of TB control: Identifying TB suspects;
Referring TB suspects for diagnosis; and Helping TB clients to complete their treatment within the
overall DOTS strategy implemented by the national TB control programme (NTCP). Through the
Swaziland Business Coalition on HIV/AIDS (SWABCHA) which coordinates, advocates, represents and
empowers private sector in issues of HIV and AIDS, SWABCHA has pledged to work with the NTCP on TB
control activities which include: TB control activities in the workplace and in the neighboring
community; collaborate in the TB/HIV control activities and advocate for the needs of employees,
including TB related health care services.
Only complete section 4.4.7 if the applicant selected Option 2 or 3 in section 3.1 of the
Proposal Form, DO NOT COMPLETE section 4.4.7 if the applicant selected Option 1 in section
3.1 of the Proposal Form

4.4.7 Links to other Global Fund resources

Describe in the table below the linkages between this Round 10 proposal and existing Global Fund
resources. It is important to list the SDAs and activities as outlined in the current proposal in the left hand
column, add a description as to how they relate to previous grants in the middle two columns, and then
outline how the Round 10 proposal specifically addresses this in the right-hand column.
Existing grants
Key SDA and activity as proposed in the
Round 10 Proposal
Round 10 proposal
1. SDA
1.1 Activity
2. SDA
2.1 Activity
2.2 Activity
 use “Tab” key to add extra rows
4.4.8 Links to non-Global Fund resources

Describe whether the Round 10 interventions (e.g. goals, objectives, SDAs, and activities) listed in
section 4.4.1 have linkages to programs financed through non-Global Fund resources. If such linkages
exist, list the non-Global Fund financed programs and their activities, and explain how the proposal
complements those programs and activities. In addition, explain how the Round 10 interventions do not
duplicate existing programs and activities supported by non-Global Fund resources.
The Swaziland Government’s TB and HIV&AIDS control efforts are currently being supported by a variety
of technical, financial and implementing partners other than the Global Fund. The main partners include
PEPFAR through the University Research Corporation (URC), MSF, KNCV, The World Bank and WHO.
Therefore, the round 10 interventions have several linkages with the existing support from these
partners. The programmatic and financial gap analysis undertaken jointly by these stakeholders ensured
that the round 10 interventions address current gaps without duplicating but rather complementing the
existing partner support. The main areas of linkages are described as follows:
PEPFAR support through University Research Corporation (URC)
The University Research Corporation (URC) is currently administering PEPFAR support to the National TB
Programme under three current projects namely: 1) the Quality Assurance project which focused on
TB/HIV and DOTS; and later transitioned to Health Care Improvement (HCI) project which will run until
2013. The HCI project includes MDR-TB technical Assistance from 2008; 2) a new CDC funded HIV
Counseling and Testing (HTC) project focusing on Provider Initiated C&T (PIHCT), and HIV prevention; 3)
from 2009, a 5-year CDC funded project on provision of HIV/AIDS and TB laboratory related technical
assistance project which will run until 2014. The specific elements of these support includes training of
health care providers on TB/HIV, laboratory strengthening, facilitating quality improvement, provision of
technical assistance in key programmatic areas and strengthening the monitoring and evaluation system.
Some of the interventions in the round 10 grant are related but not duplicating any of the PEPFAR/URC
support. For example, PEPFAR funding for 5 laboratory technologists at NRL, 9 Lay counselors in TB
clinics to facilitate HIV testing and counseling, 4 cough officers, 2 expert clients, prefabricated TB clinics
to enhance infection control in 5 hospitals, funding to upgrade the National Reference Laboratory to
provide BSL III for DST room.
MSF support
MSF started supporting Swaziland TB Control in 2008 mainly in one Region of the Country (Shiselweni).
This support compliments the national programme’s MDR-TB management efforts by specifically
providing catering for the Shiselweni Region in terms of staff training, provision of second line drugs,
laboratory strengthening and human resources. MSF teams operate in the 3 health zones of the region
namely Hlatikulu, Matsanjeni and Nhlangano. MSF doctors and nurses assist the ART clinics and TB clinics
staff in the 3 main health centres (Hlatikulu Hospital, Nhlangano Health Centre and Matsanjeni health
Centre) as well as the nursing staff working in the rural clinics. MSF is also involved in improving the
delivery of lab services at the 3 main facilities. Since March 2009, MSF teams are currently working with
17 clinics of the region in the provision of VCT, CD4 samples collection, sputum collection, refill of ARVs
and patient support and counselling. Out of the 17 clinics three (3) clinics are accredited and ready to
initiate ART and TB treatment in a routine basis. MSF is will fund treatment of about 300 MDR-TB GLC
approved cohort of patients to be recruited in 2011 in the interim pending approval of funds for second
line drugs in the round 10 proposal.
The World Bank/EU Project
The World Bank and EU intend to invest in the HIV/TB Co-epidemic Response in Swaziland the mission
worked closely with the MOH, the National TB Control Program (NTCP) and different development
partners supporting HIV/AIDS and TB (e.g. GFATM, PEPFAR, URC) to identify unfunded or underfunded
gaps that will be supported by the project. The following three areas were identified : Support HIV/TB –
IC Coordinators – one at national level and four at regional level ( 5 coordinators), training for ex-
patients on HIV/TB, MDR-TB, cough monitoring, sputum collection, mobilization of ex-patients for
patient adherence and support at 25 - 30 priority facilities, refurbishment of selected health facilities) in
order to minimize the risk of TB transmission in health facilities, refurbishment of the national TB
Centre, procure four digital x-rays at regional level and one at national level.
The WHO
WHO is the longest serving technical assistance support partner to the NTP in Swaziland and provides
biannual technical and financial support commitments to the NTP in Swaziland. Currently Swaziland has
a technical Advisor providing full time TA to the NTP including coordination of the writing committee for
the round 10 GF grant. Through the WHO/CIDA grant, WHO is helping the NTP to scale up intensified case
finding. WHO also provides TA for development of NTP strategic documents, development and printing of
IEC and R&R tools, and strengthening M&E activities.
Royal Netherlands Tuberculosis Foundation (KNCV)
KNCV started supporting the NTP in 2009 and conducts biannual TA assistance missions to the country
and provides TA on HR capacity as well.
4.4.9 Strategy to mitigate unintended consequences of additional program support on health

systems
Describe:
(a) the potential risks and unintended consequences on health systems that may result from the
implementation of the proposal; and
(b) the proposed strategy for mitigating these potentially disruptive consequences.
Most of the health system strengthening interventions that are approved in Round 8 are cross-cutting
in nature. While the NTCP is by no means intended to be an entirely vertical program or to operate in
complete isolation, the benefits of having a dedicated organizational function to direct, coordinate
and manage TB program interventions are historically proven and globally acknowledged. Interventions
to strengthen the NTCP under this proposal include a number of dedicated personnel, and some
dedicated furniture and equipment. No unintended consequences of these interventions are
anticipated.
The community-based interventions and structures to support TB program implementation that are
being proposed here (i.e. the involvement of community-members and/or organizations in program
functions such as TB suspect identification, TB screening, HIV testing, TB/HIV integration, psycho-
social support, treatment adherence support, etc.) are unprecedented in scale. This may appear as if
the TB program is operating in isolation and that TB patients are to receive more or different support
than others, a notion that needs to be mitigated. However, the NTCP is building on its achievements
and experiences in developing such community-based functions over the past years and is closely
collaborating with the HIV program to avoid vertical structures as much as possible. Therefore joint
TB/ART decentralization of services are planned and supported by each program.
The HR to be recruited under the grant are remunerated based on basic salary corresponding to
relevant government scales with only some additional provision for gratuity and other contractual
obligations. This is intended to easily fit the government remunerations system in the event of
eventual absorption of these posts.
4.5 Program Sustainability
4.5.1 Strengthening capacity and processes in tuberculosis service delivery to achieve

improved health and social outcomes
Describe how the proposal contributes to overall strengthening and/or further development of public,
private and community institutions and systems to ensure improved tuberculosis service delivery and
outcomes.
 If available, refer to country evaluation reviews
 Support explanation with excerpts from documents that the country has adopted, identifying the source, such as a National
Disease Strategy
In line with the Stop TB strategy 2006-2015 to engage all care partners, to empower communities and
patients and to contribute to health system strengthening, the NTCP will be working with Civil Society
Organizations on tuberculosis care. In addition, there will be an expanded involvement of other
providers like the private for profit institutions in order to improve access of tuberculosis prevention,
diagnostic and treatment services. In order to address the likely constraints to implementation, this
proposal has put in a number of mechanisms to contribute to further development of the public,
private and community institutions and systems to improve tuberculosis services delivery:
1. Training is an integral part of capacity building of government staff, NGOs/CSOs, private sector
clinics. This proposal provides for tailored training in management, recording and reporting and
supervision of TB services at all levels.
2. Human resources at national, sub national and Civil society levels in order to improve planning,
coordination and supervision of interventions and outcomes: at the national level, this proposal has
requested for an executive director of the national Stop TB Partnership to increase the capacity of the
newly launched Stop TB Partnership. Because of the expanded number of activities the lean staff at
the NTCP, NRL and in the peripheral laboratories, additional positions have been requested. At the
peripheral level, adherence officers, MDR-TB treatment supporters, expert clients and cough officers
will be recruited to ensure that patients are not lost to follow up and that treatment is delivered to
patients homes. It is planned that the Government of Swaziland will take up these staff after the end
of this grant.
3. Capacity building for sub-recipients to manage and coordinate sub–sub recipients is planned in the
proposal. Each of the sub-recipients will have adequate human resources (M&E and finance officers)
and training so as to ensure programme implementation and sustainability.
These measures are in line with the National Health Sector Strategic Plan 2008-2013 to enhance
efficiency and sustainability of the health sector, p.29
4.5.2 Alignment with broader developmental frameworks

Describe how the proposal’s strategy aligns with broader developmental frameworks such as:
 Poverty Reduction Strategies;
 The Highly-Indebted Poor Country (HIPC) initiative;
 The Millennium Development Goals;
 An existing national health sector development plan;
 Any other important initiatives.
Swaziland’s Poverty Reduction Strategy Paper and the National Development Strategy
The three overarching development goals of Swaziland are: fighting HIV/AIDS, reforming the economy
and improving governance. In September 2007, the Cabinet approved Swaziland’s first PRSAP
“Yingcamu - Towards Shared Growth and Empowerment - A Poverty Reduction Strategy and Action
Programme” in realization of the decline in the country’s human development index (HDI). It is the key
document to implement the country’s National Development Strategy - NDS (1997 - 2022) and the
“Vision 2022”. The overall goal of the PRSAP is to reduce poverty to 30% by 2015 and to absolutely
eradicate it by 2022. The PRSP has six pillars namely:
 Pillar1: Macroeconomic stability ad accelerated economic growth based on broad based
participation;
 Pillar 2: Empowering the poor to generate income and reduce inequalities;
 Pillar 3: Fair distribution of benefits of growth through fiscal policy;
 Pillar 4: Human Capital Development;
 Pillar 5: Improving the quality of life of the poor; and
 Pillar 6: Improving governance and strengthening institutions.
The country’s Vision 2022 has formally recognized human resource development as a key strategy for
macroeconomic growth. It stresses the need for a better health management information system,
improved health infrastructure, strengthened home based care, improved relations with NGOs,
improved security at health institutions, incentives to retain health personnel, strengthen the fight
against HIV AIDS, education campaigns, decentralization and community participation.
Most of the interventions in this proposal are directly linked to the 4th pillar Human Capital
Development pillar of the PRSP; but also indirectly related to empowerment of the poor to generate
income (pillar 2), as well as improving the quality of life of the poor (pillar 5). This is in terms of:
- The considerable investment in human resources (staffing and training) on all levels.
- reaching the poor by decentralizing services, involving NGOs in service delivery and case detection
- investments in laboratory, transport and office infrastructure
- Strengthening and expanding TB/HIV collaborative activities
- implementing infection control measures in facilities
- Investing in TB information education awareness to create demand; and strengthening the national
Stop TB Partnership.
(Sources: The World Bank. Interim Strategy Note: A Framework For Scaling Up Support For The Kingdom
Of Swaziland For The Period 04/2008-04/2010 February 26,2008; World Bank 2000: Reducing Poverty
Through Shared Growth and empowerment; Swaziland National Development Strategy)
Swaziland and the Millennium Development Goals

According to the latest report, five of the MDGs (Achieve Universal Primary Education, Promote Gender
Equality and Empower Women, Combat HIV/AIDS, Malaria and other diseases, Ensure Environmental
Sustainability and Develop a Global Partnership for Development) are likely to be achieved by 2015, if
the government and stakeholders work in a collaborative way to implement the strategies and action
plans. Primarily due to the HIV/AIDS pandemic, Swaziland is actually moving further away from the
MDG target of Goal 6 (Combat HIV/AIDS, malaria, and other diseases), however the Malaria program
has been successful in decreasing incidence and thereby positively influencing the achievement of Goal
6. The goals most lagging behind are Goals 1 (Eradicate Extreme Poverty and Hunger), 4 (Reduce Child
Mortality) and 5 (Improve Maternal Health). At the same time, Swaziland struggles with monitoring
targets due to a weak monitoring and evaluation system. This proposal addresses these shortcomings by
strengthening monitoring and evaluation within the TB program through training, revising the recording
and reporting system, implementation of and training on guidelines and providing the infrastructure for
good recording and reporting. Since tuberculosis is the main killer of PLWHA, strengthening the TB
program, especially diagnostic services, treatment supervision and improved access, and TB/HIV
collaborative services will contribute to at least halt the current move away from the MDG Goal 6. The
Swaziland MDG plan recognizes treatment of TB as a major intervention to reduce HIV-related
mortality.
(Source: Swaziland Government: Swaziland Millennium Development Goals Report for 2010)
Swaziland’s National Health Sector Strategic Plan 2008-2013

In the current NHSSP, emphasis is put on sector-wide approaches (SWAPs) and strengthening
sustainable partnerships between the MOH and all other relevant local and international stakeholders.
The four main objectives are: To reduce morbidity, disability and mortality due to diseases and social
conditions; To enhance health system capacity and performance; To promote effective allocation and
management of health and social welfare sector resources; To reduce the risk and vulnerability of the
country’s population to social welfare problems as well as the impact thereof. The three priority
strategic directions to reach the objectives are: 1. Strengthening health system capacity and
performance; 2. Improving access to essential, affordable and quality public health services towards
universal coverage; 3. Improving access to essential, affordable and quality clinical services towards
universal access. The NTCP strategic plan, which is the basis for this proposal, is fully aligned with the
NHSSP. This proposal supports the NHSSP strategies with its health system strengthening component,
improving access by decentralizing TB services and involving community based organizations and by
addressing equity in access through its community systems strengthening, gender and patient-friendly
services and responsive health system components. In addition, the quality of TB care is addressed
through the roll-out of the External Quality Assurance program for AFB microscopy and collaboration
with SNRL in South Africa for culture and DST, and strengthening the NRL for faster and reliable culture
and DST results.
Swaziland and The Global Plan to Stop TB 2006-2015
Swaziland’s main challenges to reach the Global Plan to Stop TB targets of 70% case detection and 85%
treatment success of sputum smear positive cases are the low case detection (51% in 2008) and
treatment success rate (58% in 2007). Case detection is addressed through intensified case finding
activities (cough monitors at ART sites; enablers for NGOs to screen and refer suspects; ACSM
activities) and treatment outcomes are addressed by supporting treatment adherence through
involving communities and NGOs, decentralizing services, providing incentives and enablers for patients
(transport, food supplements) and reaching out to private providers. With these measures the program
aims to improve case detection and treatment success to move closer to achievement of the Global
Plan targets.
4.5.3 Improving value for money

Explain how the program that the proposal contributes to represents good value for money.
Specifically, given the context of the epidemic in the country and the definition of value for money
provided in the Guidelines, describe how the key interventions in the proposal represent the best
balance of costs and effectiveness, with consideration to the desired achievement of both short and
long term impacts.
The development of this proposal is based on the need to scale up high quality proven
interventions that will save lives, increase health and productivity; and thereby yield value for
money. Technically appropriate interventions were selected to directly respond to the key
challenges of the country outlined in national health sector strategic plan and NTCP strategy.
Although there may be initial high capital invest in infrastructure and equipment, cost-efficiency
and hence value for money will be realized in the subsequent years of grant.
Furthermore, to ensure value for money, procurement of equipment and medicines will be done
through the most transparent means that guarantee competitive prices. For example all TB
medicines will be procured through the Global TB Drug Facility (First line drugs); and WHO Green
Light Committee (GLC) mechanisms where concessionary prices are available. Similarly
procurement of equipment will be made through a sound system that ensures the best
competiveness, and application of economies of scale through bulk purchasing where feasible.
Technical appropriateness of the implementation of the proposal interventions would be ensured

through technical assistance in TB control strategy development, development of interventions
and support in implementation by WHO, URC, KNCV, MSF and other partners. The NTCP follows
international recommendations and guidelines by WHO and leading TB control organizations
(Union, KNCV); and regular monitoring and evaluation of short-term proxy outcomes will enable
the programme to detect areas of adjustments and implement timely to avoid wastage of
resources.
The perceived specific benefits of the proposal interventions are summarized in table below:
Effectiveness:
Key investments in Short-term effect Long-term effect Intended Costs infections,
proposal impact outcomes,
care delivery
Laboratory
- Staff, trainings - reduced turnaround - less transmission of - Reduced TB High High
- Infrastructure times TB in the incidence;
- Technology - timely TB diagnosis community; - Reduced TB
- equipment - reduced treatment - improved TB related
delays treatment mortality
outcomes
MDR-TB - more MDR-TB patients - less transmission of Reduced High High

- second line drugs diagnosed and drug resistant incidence of
- staff, trainings treated strains in the drug-resistant
- transport - more patients cured community TB
- patient support - less mortality - increase treatment
- success rate
Effectiveness:
Key investments in Short-term effect Long-term effect Intended Costs infections,
proposal impact outcomes,
care delivery
M&E Improved knowledge - Improved and More numbers High Medium

- electronic patient on realigned TB of TB cases
management - true disease burden control strategy timely
system in the country - Improved response diagnosed and
- prevalence survey - effectiveness of TB to epidemiology successfully
- external program control interventions and drivers of treated without
evaluation - challenges in TB disease creating drug
- Operational control strategy - Up to date resistance
research information on
current status of
TB control program
Human Resource - more staff can
Development diagnose and support - Improved case - Reduced Medi High
- Medical doctors more patients detection and incidence of um
- Nurses - more availability of treatment TB
- NTCP staff care outcomes - Reduced TB
- trainings - health system - Less transmission mortality
supported to cope of TB in the
with massive disease community
burden
TB/HIV - better diagnosis of - improved - Less mortality Medi High

- Regional co-infections coordination of HIV+ TB um
committees - quality data between TB and patients
- Recording and - knowledgeable HIV programs - Reduced
reporting tools health care workers - improved care for incidence of
- Equipment (x-rays) - reduced TB HIV co-infected TB TB among
- trainings diagnostic delays patients PLWHA
Infection Control - knowledgeable HCWs - reduced risk of Reduced Medi High

- staff & trainings - improved nosocomial incidence of TB um
- infrastructure infrastructure transmissions of TB among health
- personal & - personal protection - healthy staff care workers
environmental available and health care
measures - safe working seeking people
- coordination environment
- increased staff
motivation
ACSM & CSS
- IEC materials - Awareness of TB - Reduced stigma Improved case Medi Medium
- Awareness symptoms, against PLWHA and detection and um
campaigns treatment, TB treatment
- NGO collaboration prevention among - Reduced gender- outcomes
- Advocacy patients, general inequalities in
- Trainings & staff public, communities access to care Equity in health
- Stop TB - Strengthened - Empowered women care and society
Partnership community systems & girls, patients
- Gender & stigma - Sensitized key target - Policy and Government
awareness groups (women, behaviour change held
- Patient charter girls, boys, men) - Reduced delays in accountable by
- Community seeking care & civil society
sensitization reduced mortality
Technical Assistance - Activities - Improved quality of Reduced Medi Medium

For prevalence implemented timely TB control program incidence of TB um
survey, MDR-TB, and with quality - Improved quality of and drug-
strategy and - According to health care resistant TB
operations, GF international services
implementation, standards and - Capacitated NTCP Improved
ACSM, Operational guidelines staff treatment
Research - Targets achieved outcomes
Gaps in knowledge to answer this section:
- It is difficult to put a value on cases of TB averted or cases successfully treated.
- It would not be enough to take the sum of all costs of interventions and divide it by number of
patients successfully treated – this does not take into account the long-term effects of
measures and the benefit to the broader health system.
- It is difficult to quantify to what extent TB interventions have an impact on rest of the health
system and costs of the system. It also does not take into account the indirect and intangible
costs borne by the patient.
- It is not possible to calculate the net present value of investments, as we do not have the data
for this, nor the tools or the time or capacity (health economist needed).
- In general it is evident that failure to invest now will only increase the disease burden and the
future consequences could be overwhelming. For example, in Swaziland the HIV and TB
programs only started to take off in 2006 and by that time the problem was huge. The problem
would have been smaller, if investments would have been made in the 1990s to contain the
spread of HIV and TB.
4.6 Monitoring and Evaluation System
4.6.1 Impact and outcome measurement systems
Describe the impact and outcome measurement systems, including strengths and weaknesses, used to measure achievements of the program at impact
and outcome level.
Recording and reporting system

The Swaziland National TB Control programme has established standardized recording of individual patient data, including information on treatment
outcomes, which are then used to compile quarterly treatment outcomes in cohorts of patients. These data are compiled and analyzed at the facility
level and are used to monitor treatment outcomes, and also used to identify local problems as they arise, and, at regional and national level to ensure
consistently high-quality TB control across country. Regular programme supervision is carried out by the NTCP staff and technical staff from the NTP
technical partners like WHO, MSF and URC to verify the quality of information and to address performance problems. In addition, in order capture case
finding and monitor TB/HIV testing, diagnostic information, including sputum culture, DST and HIV test results, used to guide patient management
captured. The TB programme uses both the manual and electronic recording systems (ETR.Net) and has standardized records and reports from private
care providers to the national TB programme (NTP) recording and reporting system.
TB impact measurement
TB impact measurement has two major components. The first is measuring the epidemiological burden of TB, and trends in this burden, in terms of
three so-called "impact indicators": incidence (the number of newly-arising cases of TB each year), prevalence (the number of cases of TB in the
population at a given point in time) and mortality (the number of deaths from TB in a given year). These are the major indicators are also used to
measure progress in TB control at global level: Millennium Development Goals (MDGs) and by WHO. Swaziland relies on the WHO annual TB global
report for these indicators. On an annual basis, the NTCP submits case finding and treatment outcome data to the WHO country office, which then
submits to WHO headquarters for further analysis and estimation of the epidemiological burden.
The second major component of TB impact measurement is evaluation of the extent to which interventions to control TB are responsible for changes in
incidence, prevalence and mortality ("impact evaluation"). The NTCP in conjunction with major partners conducts TB control review missions from time
to time, notably- WHO lead mission of international partners (March 2007), KNCV lead missions, Nov 2008 and March 2009, GLC and GDF missions of 2009
that provide proxy impact evaluation of TB control efforts.
Strengths
 A full-time employee is dedicated to M&E at the National TB Control programme
 The NTCP currently has an existing M&E framework specifically for TB to track its strategic plan objectives 2010-2015.
 An M&E system was initiated to develop a broader M&E framework for TB impact measurement in alignment with the national TB guidelines and
international guidelines.
 Regional coordinators involved in collection of data
 NTCP and partners conduct quarterly data review meetings at national level
 Individual facilities have TB/HIV quality improvement teams and discuss facility data regularly and formulate improvement objectives and
targets
 The electronic TB register was adapted to the Swaziland recording and reporting system on the national level and is being strengthened on the
regional level. Training of staff in this new system and the use of the new registers is ongoing.
 Specialized surveillance, based on WHO international guidelines, has been integrated for HIV testing among TB patients. HIV testing recording
and reporting is integrated into the electronic database.
 MDR-TB registers, based on WHO guidelines, have been developed and printed. The registers are currently being utilized to record and report
diagnosis and follow-up for MDRTB patients.
 TB/HIV indicators are included in the M&E Framework for the Health sector response to HIV and AIDS
 Health Information Systems coordinating committee (HISCC) of which TB, SNAP M&E and MOH/HMIS(Health Management Information Systems)
are currently collaborating for a better coordination and linkages between TB and HIV programmes as well as a broader health sector approach.
 Technical assistance partners support some of the monitoring and impact evaluation efforts
Weaknesses
 There is still a weak collaboration with the HIV implementation level in that some indicators referring to TB/HIV have not been completely
harmonized,
 A standardized recording and reporting system for community DOTS has not yet been established. While there is a system with a ‘yellow card’ to
track community DOTS, this system needs to be further strengthened
 The current TB M&E system is lacking a working document on TB M&E which specifies requisite training, supervision guidelines, planning and
coverage.
 Data entry at facility level into the electronic system is faced with acceptance challenges from some focal people who believe that this task
should be allocated to data clerks because they lack time for this activity although it is now considered a core TB management duty.
 Linkages between programmed activities and expenditures need to be strengthened.
 Reporting systems prisons remain weak and are not properly linked with the NTCP’s new recording and reporting system
4.6.2 Impact and outcome measurement
 insert source (large scale surveys,

(a) Has impact and/or outcome
Yes No (b) What was the source(s) of demographic surveillance, vital registration
data been collected in the last 2 systems, other)
 answer section  go to section the measurement?
years? 4.6.2 (b) 4.6.2 (c)
(c) It is important to guarantee that there are systems in place to measure all impact and outcome indicators in the performance framework. In order
to do this, fill in the table below, fully describing all planned surveys, surveillance activities and routine data collection in country used to measure
impact and outcome indicators relevant to the proposal. Add rows as needed.
Years of Implementation Impact/Outcome Indicators
Data Source Funding relevant to the proposal to be
2011 2012 2013 2014 2015
measured by data source
Total cost
$1,000,0 TB Prevalence
00
Source 1 Secured funding amount and funding source 0
TB Prevalence Survey Funding gap
$1,000,0
00
Round 10 funding request for Source 1 0
Total cost
Source 2
(large scale surveys, Secured funding amount and funding source
demographic surveillance, vital Funding gap
registration systems, other) Round 10 funding request for Source 2
Total cost
Source 3
(large scale surveys, Secured funding amount and funding source
demographic surveillance, vital Funding gap
registration systems, other) Round 10 funding request for Source 3
4.6.3 Links with the National M&E System

(a) Describe how the monitoring and evaluation (M&E) arrangements in the proposal (at the Principal
Recipient, Sub-recipient, and other levels) use existing national indicators, data collection tools and
reporting systems including reporting channels and cycles.
ONE PAGE MAXIMUM

The M&E system in Swaziland has eveolved over the last 5 years when the system only existed as the
Statistics unit with limited data management capabilities, to the HIV and AIDS M&E unit which focused
more on HIV and AIDS data management. The Global Fund process through series of M&E Systems
Strengthening workshops involving a broad stakeholders participation has played a key role in
broadening the thinking around the national M&E system to meet reporting requirements of all partners
including Global Fund, PEPFAR, NGOs and others.
In July 2009, the country’s M&E system evoleved further when the Ministry of Health launched its
Strategic Information Department (SID) comprising of three units namely: 1) Monitoring and Evluation
(M&E), 2) Health Management and Information System (HMIS); and 3) Research. The main objective of
the SID is to provide necessary data to inform evidenced-based policy decisions as well as providing the
framework for integrating all stakeholders M&E requirements. The Health Sector M&E system therefore
has defined national indicators, defined data sources, data collection tools and methods, data quality
and reporting protocols. The department is manned by cross-cutting teams for data quality/analysis
and reporting. The Procurement and supply management system of the ministry of health has also been
upgraded to an electronic management system. The data flow process in the current national M&E
system is as follows:
 Facility level - data collection, initial data collation (Manual processes); and the main M&E
process involves tracking outputs
 Regional level - Data entry (Computerized and linked through a Wide Area Network ); and the
main M&E process includes tracking outputs and outcomes;
 National level - Analysis-reporting and dissemination (Access data through a WAN); and the
main M&E process includes the tracking of outcomes and impact.
The Principal Recipient (NERCHA), having been responsible for coordinating the national HIV and AIDS
response in the country since 2001 as well as administering the Global Fund grants for AIDS, TB and
Malaria, has also played key role in linking the Global Fund Sub-recipients to the national M&E system
of using national indicators, data collection tools and reporing protocols. Therefore a national health
sector M&E system that provides the framework for global fund reporting already exists.
Currently, disease-specific programmes like TB and Malaria still operate a semi-vertical M&E system
that feeds into the national M&E through quarterly reporting inclduing progress of Global Fund
supported activities. However, the medium plan of the Strategic Information Department is to
integrate programme-specific M&E systems especially for Malaria, HIV and AIDS and Tuberculosis into
one comprehensive national health sector M&E within the next 5 years. The whole system is being
guided by a national M&E task force.
NERCHA, the proposed principal recipient of this grant is one of the major stakeholders involved in the
development of the new national M&E system and alingnment with programnme M&E. One of the key
responsibilities and priorities of NERCHA as PR for the R8 TB grant is to ensure that activities are
carried out effectively and timely towards achievements of the set targets of detecting and treating TB
patients as stipulated in the grant proposal. This will entail effective monitoring of the activities of the
implementers in various settings and locations across Swaziland. In addition to reporting on the
standard epidemiological indicators of the NTP, NERCHA will also ensure timely reporting of the
Progress Update and Disbursement Requests (DR/PU).
Based on the activities of the implementers, the following monitoring tools will be developed and used:
 a checklist for field monitoring of activities
 adapt a progress update reporting form for SRs (implementers)
In order to ensure effective monitoring mechanism for SR activities, the following have been planned:
 a grant procedure manual for reporting currently in process;
 strengthening oversight functions through regular supervision;
 Orientation of PR staff and implementers on reporting protocols and procedures.
In this regard, all implementers of this proposal will automatically be linked to the national TB M&E
system, and will be feeding into the national M&E on a quarterly basis. The proposed indicators in the
Performance Framework (PF) will be monitored using the same system whereby, in each quarter,
reports specific to the Global fund will be submitted to the MOH/GF in i) a short narrative; (ii) an
update on the achievements in the main GF activities and a comprehensive report sent to the GF.
At the most recent M&E strengthening assessment workshop held in March 2010, one of the key
weaknesses found relate to reporting progress of community-based systems activities. As the Round 10
consolidated grant proposal for TB involves a considerable amount of such community-based activities,
the programme intends to work with the Principal Recipient and other stakeholders in the M&E task
force to address community reporting systems.
(b) Are all of the M&E arrangements planned for the proposal Yes No
using the national M&E system?  go to section  continue to
4.6.4 section 4.6.3 (c)
(c) If no, explain why not and list any service delivery areas (SDAs) and/or activities that will not be
monitored through the national M&E system.
ONE PAGE MAXIMUM

Not applicable
4.6.4 Strengthening monitoring and evaluation systems
(a) Has a multi-stakeholder national M&E assessment been Yes No

recently conducted (in last 2 years)?  continue to
 go to section 4.7
section 4.6.4 (b)
(b) If yes, has a costed M&E action plan been developed or Yes
No
updated to include identified M&E strengthening measures?  continue to
 go to section 4.7
section 4.6.4 (c)
(c) Describe whether the proposal is requesting funding for any M&E strengthening measures. These
strengthening measures may have been identified through a national M&E assessment or any other
relevant evaluation or review process.
HALF PAGE MAXIMUM

In 2008 October 22nd to 24th, a National TB Programme M&E Systems Strengthening self-assessment
workshop was conducted with the participation of all stakeholders resulting in the development of an
M&E systems strengthening action plan for both the programme and PR that will guarantee effective
and reliable monitoring and evaluation systems for TB control in Swaziland. This activity also served to
reposition the PR for effective implementation of the Round 8 TB and Malaria grants. From 2009 to
date, the national TB Programme in collaboration with the PR has implemented most of the
strengthening measures identified during the October 2008 workshop.
This proposal includes a funding request to organize a follow-up workshop to re-assess the M&E
Systems and to implement further strengthening measures that may be identified and recommended
by the MESST workshop. It is foreseen that this workshop will be held before or during grant
negotiations in the first quarter of 2011.
The proposal also includes funding request for an external mid-term review as well as an end
evaluation of the national TB Strategic Plan 2010-2014.
4.7 Implementation Capacity
4.7.1 Principal Recipient(s)

Describe the technical, managerial and financial capacities of each Principal Recipient (PR) to manage
and oversee implementation. Include any anticipated limitations to strong performance and refer to
any existing assessments of the PR, other than Global Fund reporting mechanisms.
 Copy and paste tables below if there more than three Principal Recipients
National Emergency
PR 1 Name Response Council on HIV Sector Government
and AIDS (NERCHA)
Street Address P.O. Box 1937, Mbabane, H100, Swaziland
NERCHA was established at the end of 2001 as a coordination mechanism for the multi-sectoral
response to HIV and AIDS (including TB) in the country. Their objectives are analogous to those
indicated for the CCM and its operational structure (Directorate). As such, NERCHA has the
characteristics asked for by the GFATM for a Principal Recipient. Full capacity and procedures have
been in place and tested over the last five and a half years for the management of an increasing
amount of resources. NERCHA has been assessed by the Global Fund, in past years, and continues to
have a comparative advantage in channeling the GFATM funds through a mechanism common to other
public and private sources (minimizing transaction costs, promoting ownership, supporting institutional
development, etc.) making the use of NERCHA as the PR the first choice. NERCHA has proven its
capacity through the management and disbursement more than US$ 60 million delivered through a
variety of stakeholders and partners.
NERCHA has the technical, managerial, and financial competencies to handle the functions of the
Principal Recipient. It also has an M&E unit that is well placed to undertake the monitoring and
evaluation role required for external donors such as the Global Fund. NERCHA is also well placed to
handle the tracking of interventions in the country and to ensure equity, sustainability and quality
assurance, through its sectoral and regional approach supported by its units. At the same time, NERCHA
is well positioned to strengthen the capacity of the public, private and civil society sectors to
coordinate and manage their sectoral responses.
PR 2 Name Sector
Street Address
 Description
PR 3 Name Sector
Street Address
 Description
4.7.2 Sub-recipients
Yes  go to section 4.7.2 (c)

(a) Will Sub-recipients be involved in implementation?
No  go to section 4.7.2 (b)
(b) If no, why not?
HALF PAGE MAXIMUM
(c) If yes, how many Sub-recipients will be involved? 1-6 7-20 21-50 50+
Yes No
(d) Are all Sub-recipients already identified?  go to sections
4.7.2 (e) and (f)  go to section 4.7.3
(e) List the identified Sub-recipients and describe:

 The work to be undertaken by each Sub-recipient;
 Past implementation experience of each Sub-recipient;
 Any challenges that could affect performance of each Sub-recipient as well as a mitigation
strategy to address this.
TWO PAGE MAXIMUM

So far, Four sub-recipients have been identified for the above functions.
1-Good Shepherd Hospital (GSH):
Work to be undertaken: Pursue high quality DOTS enhancement and expansion (Improving TB diagnosis,
High quality DOTS, Patient support, M&E and impact measurement; Address TB/HIV (TB/HIV
collaborative activities)
Geographical coverage: Lubombo Region: Community DOTS and patient support services provide by
CSOs and Catholic clinics
Past Implementation Experience: The Good Shepherd Hospital (GSH) has a very strong track-record in
TB program implementation, as a result of almost 20 years of collaboration with the Nuffield Centre for
International Health, Leeds and Bradford Universities. Treatment of both TB and HIV/AIDS was further
‘rolled out’ through a clinic-based treatment program in 2005. GSH has been a very important NTP
collaborator at the program implementation level for many years and is well positioned to take on a
leadership role in the further strengthening of TB program implementation.
GSH already works very closely with community partners and faith based organizations as sub recipient
of GF Round 8. In view of the above, the internal capacity for such functions within GSH has been
strengthened through the employment of two persons in the round 8 GF grant: 1) Administrative and
financial oversight Officer to work with different implementing partners on financial matters, and
assist with the development of work plans and 2) the monitoring and evaluation officer to handle the
SSR monitoring aspects of both the program and financial management
Challenges and mitigation strategy: Even though there are staff accountants and data auditors
available at the hospital, keeping track of the different work plans, funding streams and reports may
be challenging.
2-Swaziland STOP TB Partnership (SSTP):

Work to be undertaken: Empower people with TB, and communities (Advocacy, Communication and
Social Mobilization, Stop TB Partnering initiatives at country level: strengthening and maintenance of
the Swaziland Stop TB Partnership, Building community linkages, collaboration and coordination,
Human resources: skills building for service delivery, advocacy and leadership, and Community based
activities and services - delivery, use and quality)
Geographical coverage-National
Past Implementation Experience: The Swaziland STOP TB Partnership (SSTP) is a relatively new
organization in Swaziland created in March 2009. The SSTP was formed to complement government’s
role to ensure services are delivered, which does not imply that direct provision by government is the
only route through which services are provided. The STP was involved in mobilization of proposals from
the membership for the round 10 GF proposal. Although in Swaziland the implementation experience is
still weak, and it has not previously provided it partners with funding and/or program oversight, this
will be a new role for STP and will require additional institutional capacity and drawing of experiences
will be drawn from other STPs.
Challenges and mitigation strategy: There are only two staff in the SSTP secretariat and partnership
does not have staff responsible for finance and monitoring functions. The Full STP is not yet
constituted as per the organogram and there is no chairman or board in place. Accountability to the
STP members is still weak and since the appointment of the two staff, the STP has not had a board
meeting. Therefore planning, management, controlling and directing functions of the partnership will
need to be strengthened. Full constitution of the partnership board is planned in the coming quarter
where the care-taker chairmanship by the NTP will be handed over to the elected partnership chairman
and board. Under R10, it is proposed that two additional officers will be hired to strengthen the
management functions. The functions of the current staff will be streamlined to support financial,
administrative and monitoring functions for the grant as well. The PR will organize capacity building
workshop for the STP on GF and will provide continuous implementation support to the SR.
3-University Research Co., LLC (URC)

Work to be undertaken: Pursue high quality DOTS enhancement and expansion (Improving TB diagnosis
& High quality DOTS; Address TB/HIV (TB/HIV collaborative activities, Infection Control, High Risk
Groups and Address Childhood TB); Prevention and Management of drug resistant TB (Drug resistant TB
treatment and MDR-TB treatment support)
Geographical coverage-Manzini and Hhohho
Past Implementation Experience: URC works closely with NTCP, SNAP, Clinical Laboratory services and
local partners to apply innovative approaches to improve health worker HIV/AIDS and tuberculosis skills
and performance, including programmatic management of drug-resistant TB; introducing and scale up
best practices in the delivery of key TB and HIV/AIDS services, including counseling and testing (C&T);
strengthening integration for HIV and tuberculosis clinical and community-based services; advocacy and
technical assistance for strengthened TB and TB/HIV information management systems; and improving
laboratory related services. URC is currently implementing three USAID and CDC funded projects in
Swaziland, which focuses on building public sector capacity to provide high-quality, integrated TB, HIV
and MDR-TB services; improving delivery of provider-initiated HIV testing in TB services; and
addressing the critical gaps in high quality, rapid, and reliable TB and HIV laboratory services
nationwide. It has well structured financial and monitoring departments and a host of technical
advisors. URC also implements small grants to CSOs including Women Together and The AIDS Support
Centre (TASC).URC has been a critical partner to the recent improvements in the performance of the
NTP since 2006, implementation of the R3 GF TB grant and coordinated the writing of the successful GF
round 8 GF grant.
Challenges and mitigation strategy: Although URC has the above structure, systems and resources,
however, in order to implement the GF grant, specific personnel will be required to run the GF grant
functions, that is, a GF programme officer and GF Finance and Admin Officer.
4-Medicins Sans Frontiers (MSF)

Work to be undertaken: Pursue high quality DOTS enhancement and expansion (Improving TB diagnosis
& High quality DOTS; Address TB/HIV (TB/HIV collaborative activities, Infection Control, High Risk
Groups and Address Childhood TB); Prevention and Management of drug resistant TB (Drug resistant TB
treatment and MDR-TB treatment support)
Geographical coverage-Shiselweni
Past Implementation Experience : MSF doctors and nurses assist the ART clinics and TB clinics staff in
the 3 main health centres (Hlatikulu Hospital, Nhlangano Health Centre and Matsanjeni health Centre)
as well as the nursing staff working in the rural clinics. MSF is also involved in improving the delivery of
lab services at the 3 main facilities. Since March 2009, MSF teams are currently working with 17 clinics
of the region in the provision of VCT, CD4 samples collection, sputum collection, refill of ARVs and
patient support and counselling. Out of the 17 clinics three (3) clinics are accredited and ready to
initiate ART and TB treatment in a routine basis. MSF is funding treatment of about 300 MDR-TB
patients in the interim pending approval of funds for second line drugs in the round 10 proposal. MSF
has an elaborate administrative and financial and monitoring system.
Challenges and mitigation strategy: Although MSF has the above structure, systems and resources,
however, in order to implement the GF grant, specific personnel will be required to run the GF grant
functions, that is, a GF programme and monitoring officer
(f) If the private sector and/or civil society are not involved as Sub-recipients in implementation, or
only involved in a limited way, explain why.
HALF PAGE MAXIMUM
4.7.3 Sub-recipients to be identified
Describe:
(a) why some or all of the Sub-recipients are not already identified; and
(b) the transparent, time-bound process that the Principal Recipient(s) will use to select Sub-
recipients and not delay program performance.
ONE PAGE MAXIMUM

No yet to be identified sub-recipients
4.7.4 Coordination between or among implementers

Describe:
(a) how coordination will occur between multiple Principal Recipients if there is more than one
nominated Principal Recipient for the proposal; and
(b) how coordination will occur between each nominated Principal Recipient and its respective Sub-
recipient to ensure timely and transparent program performance.
The Principal Recipient will coordinate all recipients of Global Fund funds directly and through 2-3 sub-
recipients. However, the Kingdom of Swaziland also provides significant funds for the procurement of
drugs, including all funds for the procurement of first line anti TB drugs. Through CMS , the NTP and
the national referral laboratory, public and private facilities will be able to obtain drugs and laboratory
reagents. While the Principal Recipient will undertake the coordination role, the overall policy and
coordination role for procurement lies with the MOHSW.
Each of the Sub recipients will coordinate 5-6 individual and sectors organizations demarcated by
geographical coverage and sector. Good Shepherd hospital will focus on the sub sub recipients in the
Lubombo region and the catholic clinics, The Swaziland Stop TB Partnership will focus on the objective
4 activities related to Advocacy, Communication and Social Mobilization and CBO activities across the
country while the NTP and the PR will work with the public health facilities. MSF will be sub-recipient
for Part of the MDR-TB community-based programme and will administer support for maintain lay
counselors, expert clients and MDR-TB treatment in Shiselweni region. The applicant will organize
periodic meetings between the PR and sub recipients on a monthly basis and separate for all
implementation agencies on a quarterly basis. These meetings will be used to plan, discuss
implementation challenges and trouble shoot problems and constraints. Every quarter, the PR, sub
recipient and the NTP will meet to discuss quarterly reports before submission to the GF.
From the technical side, the current NTCP partners, WHO, PEPFAR, URC and MSF will support the
implementation of the grant.
4.7.5 Strengthening implementation capacity
(a) The applicant is encouraged to include a funding request for management and/or technical
assistance to achieve strengthened capacity and high quality services, supported by a summary of a
technical assistance (TA) plan based on the indicative percentage range in the Guidelines. In the table
below provide a summary of the TA plan.
 Refer to the Strengthening Implementation Capacity information note for further background and detail
Management Management and/or Intended beneficiary of Estimated cost

Estimated
and/or technical technical assistance management and/or  same as
timeline
assistance need activity technical assistance proposal currency
3 country support
MDR-TB, PSM, missions per year by
NTCP, NRL, pharmacist Year 1, 2, 4, 5
laboratory, HR external consultant on 159,272
specific program areas
TA to develop advanced
integrated TB/HIV
HR training curriculum for NTCP, TB/HIV focal point Year 1 14,945
medical officers and
nurses
short term consultancy on
IC, MDR-TB, CB-
key program areas (1-3 NTCP Year 1, 2, 4, 5 88,484
DOTs, TB/HIV
months duration
Program
Long-term resident TB
management, NTCP, program manager Year 2-5 1,115,730
advisor for NTCP
strategic planning
Program Conduct external program
NTCP Year 1, 2, 5 32,509.71
management evaluation
(b) Describe the process used to identify the assistance needs listed in the above table.
The assistance needs are based on the Swaziland NTCP strategic plan 2010-2014 and the difference
between needed and available capacity in the country identified by the NTCP. Hence, the strategic
plan was consulted to identify the future capacity needs of the country to reach the primary objectives
of the plan. Following, the NTCP identified its current capacity gaps to fulfill these objectives and the
technical assistance needed to build up capacity or fill current and projected future gaps.
(c) If no request for management and/or technical assistance is included in the proposal, provide a
justification below. Or, if the funding request is outside the indicative percentage range, provide a
justification below.
Not applicable
4.8 Pharmaceutical and Other Health Products
4.8.1 Scope of Round 10 proposal
Yes  go to section 4.8.2

Does the proposal seek funding for any
pharmaceutical and/or health products?
No  skip the remainder of section 4.8
4.8.2 Table of roles and responsibilities

Does the
proposal request
funding for
Name of the organization(s) Role of the organization(s) additional staff
Function
responsible for this function responsible for this function or technical
assistance?
 indicate Yes or
No
Procurement policies, NERCHA has documented
systems and planning procurement procedures
that clearly enforce
transparency and
competitiveness. A
procurement office exists
within NERCHA and it is
responsible for all
procurement conducted
by the organization. It is
comprised of a
Procurement Manager,
Procurement Officer and
Procurement Clerk. This
office works hand in hand
with the Finance Office
which comprises the
Director-Technical,
Finance Manager,
NERCHA Accountant, Payments and NO
Credit Control Sections.
There is an independent
Tender Board that
approves procurement of
both health and non-
health products for more
than specific thresholds.
NERCHA, in collaboration
with the Ministry of Health
(Chief Pharmacist’s
office), and the
Laboratory Services are
currently able to select
and manage appropriate
procurement procedures
according to type and
volumes of
pharmaceutical and health
products to be purchased.
The Green Light has

granted approval for
Swaziland’s MDR-TB
programme and therefore
eligible to access second
anti-TB drugs through the
GLC mechanism. All
second line anti-TB drugs
to be procured using this
grant will be done through
the GLC mechanism.
Intellectual property Ministry of Justice The Ministry of Justice is
regulations responsible of determining No
any regulations on what
can be imported into the
country.
Quality Assurance and Currently Swaziland has
quality control no Drug Regulatory
Agency. However, the
concept is being
developed and in the
meantime, the products to
be procured under this
grant will be from
suppliers that meet the
Global Fund QA policy
Ministry of Health No
and/or WHO pre-
qualification or registered
for use in ICH country.
The PR takes cognizance
of the revised Global Fund
QA policy which came into
effect on 1st July 2009,
and will ensure full
compliance with its
provisions
Management and Second line anti-TB drugs
Coordination and other health products
will be procured using
funding from this grant.
However, Swaziland
Government also provides
funding for procurement
of first and second line
anti-TB drugs, laboratory
NERCHA equipment, reagents and
other supplies. While Yes
Ministry of Health NERCHA is responsible for
procurement using GFATM
funds, the Government
Procurement Unit in the
Ministry of Finance in
collaboration with the
Ministry of Health, has
responsibility for all
procurement using
Swaziland Government
funds. For procurement of
products using Global
Fund resources, the
National TB Program and
the National Laboratory
determine the needs and
specifications and then
liaise with NERCHA who
will effect the
procurement. They will
also ensure
complimentarily in the
procurement planning
process and efficient use
of both Government and
GFATM resources.
Product Selection The Product selection for
this grant falls under two
main categories namely
the anti-TB drugs and
laboratory equipment and
supplies. Their selection is
based on the approved
standardized treatment
regimen as contained in
the Swaziland DR-TB
management guidelines,
which is based on the
WHO guidelines for
managing drug resistant
tuberculosis.
With respect to the

Ministry of Health NO
laboratory equipment and
supplies, the selection of
products is based on the
WHO recommended
standard list for myco-
bacterial microscopy,
culture and Drug
Susceptibility Testing
(DST) laboratory services.
The National Reference
laboratory is responsible
for providing the exact
specification of
equipment, reagents and
supplies in accordance
with WHO
recommendations.
Management Information The National TB Program
Systems (MIS) has an established
information system that
captures TB case
Ministry of Health treatment from Yes
identification to
conversion and outcome.
This system captures the
data from all facilities and
reporting is done to the
national program. The
report indicates the
number of cases requiring
treatment with specific
regimen, but not on stock
and utilization of anti-TB
drugs. The Central Medical
Stores (CMS) is the
national warehouse for
drugs and health products
and procures non-Global
Fund funded health
products on behalf of the
government. It is fully
responsible for stock
management and
distribution of
pharmaceuticals procured
by NERCHA using Global
Fund resources. The
inventory management
system at the Central
Medical Stores is
computerized, while a
paper-based system
operates at facility level.
The electronic system at
the CMS generates reports
of stock position by batch
and expiry dates.
Forecasting The National TB Program
is responsible for
quantification of anti-TB
drugs to be procured.
Storage and Inventory Ministry of Health The Ministry of Health
Management stores inventory at the
Central Medical Stores. No
Electronic system is
utilized to monitor and
manage the stocks. In
addition, manual stock
cards are in place as a
back-up
Distribution to other Distribution to other
stores and end-users stores is done through the
Central Medical Stores
distribution System. The
Central Medical Stores
keeps the bulk of the
stock, and the NTCP
Ministry of Health orders quarterly supplies Yes
for distribution to the
peripheral units based on
need and serves as a
central storage for the
peripheral sites. The
central level delivers
supplies to the peripheral
sites on a monthly basis
while allowing emergency
deliveries when the need
arises.
Ensuring rational use and Prescription for all TB
patient safety treatment is done in
accordance with standard
treatment guidelines.
Pharmacovigilance n/a
Drug resistance n/a
Surveillance
4.8.3 Past management experience

Describe the past experience of each organization that will be involved in managing pharmaceutical
and other health products.
Total value procured

during
Organization name Short description of management experience
last financial year
 same currency as proposal
Ministry of Health The Ministry of Health through the Central
Medical stores is responsible for managing
pharmaceutical services. It receives
technical assistance on Supply Chain US$ 700, 000 – 00 for
Management and overall Pharmaceutical TB drugs
Systems Strengthening from in-country
partners.
 use the ‘Tab’ key to add extra

rows
4.8.4 Alignment with existing systems
Describe how the proposal uses existing country systems for the management of the additional
pharmaceutical and health product activities that are planned, including pharmacovigilance and drug
resistance surveillance systems. If existing systems are not used, explain why.
ONE PAGE MAXIMUM

The management of the additional pharmaceutical and health products procured through this proposal
will use the existing in-country systems. The newly established Procurement Unit in the Ministry of
Health (MOH) will ultimately oversee all procurement activities and all procurement process will
comply with the MOH procurement policies.
4.8.5 Storage and distribution systems
National medical stores or equivalent
(a) Which organization(s) have
primary responsibility to
CENTRAL MEDICAL STORES
provide storage and Sub-contracted national organization(s)
distribution services under
the proposal?  specify
Sub-contracted international organization(s)

 tick the corresponding
boxes to the right and enter  specify
the name of the
organization(s) Other:
 specify
(b) For storage partners, what is each organization's current storage capacity for pharmaceutical and
health products? If the proposal represents a significant change in the volume of products to be
stored, estimate the relative change in percent, and explain what plans are in place to ensure
increased capacity.
ONE PAGE MAXIMUM
The Ministry of Health is responsible for storage capacity for pharmaceutical and health products at the
Central Medical Stores. The MoH is currently working to increase the storage capacity at central level
and then decentralise it at regional level. In addition, the MoH is planning to extend and rehabilitate
storage spaces at clinic level in order to meet the storage needs and provide dedicated storage areas
for other health products.
(c) For distribution partners, what is each organization's current distribution capacity for
pharmaceutical and health products? If the proposal represents a significant change in the
volume of products to be distributed or the area(s) where distribution will occur, estimate the
relative change in percent, and explain what plans are in place to ensure increased capacity.
ONE PAGE MAXIMUM
The Ministry of Health through the Central Medical Stores is currently responsible for storage and
distribution of pharmaceutical and health products. The MoH is also exploring the idea of idea of
decentralizing the Central Medical Stores at regional level in order to strengthen the linkages with the
health facilities, especially with the health clinics and thus improve the quality of drugs supply and
management.
4.8.6 Pharmaceutical and health products for initial two years
Complete the Pharmaceutical and Health Products List and list all of the products that are requested
to be funded through the proposal.
If the pharmaceutical products included in the Pharmaceutical and Health Products List are not
included in the current national, institutional or World Health Organization Standard Treatment
Guidelines (STGs), or Essential Medicines Lists (EMLs), describe below the STGs that are planned to be
utilized, and the rationale for their use.
Applicants are invited to justify the prices based on either the range provided in the Unit Costs for
Selected Key Health Products information note or with another published international reference
source. If the provided price is out of range, provide justification. Also, if local legislation is preventing
access to low cost prices through local manufacturers or similar mandates, clarification should be
provided as well as a plan for addressing such barriers over the life of the proposal.
ONE PAGE MAXIMUM

In this proposal, procurement of second line anti-TB medications has been planned throughout the 5
year-period. The medications planned include: Amikacin, Capreomycin, Levofloxacin,
Ethionamide, Terizidon and PAS. As Swaziland is already implementing a GLC approved
project, the drugs planned in this proposal will be procured through the GLC mechanism. The
unit costs used in the costing of the medications are based on the latest procurement made
through the GLC.
WHO National Institutional
Listed in Listed in Listed in
STG STG STG
Product Listed in Listed in Listed in
Product (Generic Name) (indicate (indicate (indicate
Category EML st nd EML EML
1 /2 line 1st/2nd line 1st/2nd line
(Yes/No) (Yes/No) (Yes/No)
treatment treatment treatment
) ) )
nd nd nd
2 Line Yes 2 Line Yes Yes, 2 n/a n/a
anti-TB
Amikacin 500mg / 2ml Line
Drugs Capreomycin 1 gr vial Yes 2
nd
Line Yes Yes, 2
nd
n/a n/a
Line
Levofloxacin 500mg tablets Yes 2
nd
Line Yes Yes,2
nd
n/a n/a
Line
Ethionamide 250mg tablets Yes 2nd
Line Yes Yes, 2nd n/a n/a
Line
Yes 2nd Line Yes Yes, 2nd n/a n/a
Terizidone 250mg Line
PAS 4 gr satchets Yes 2nd
Line Yes Yes, 2nd n/a n/a
Line
There is no existing legislation in Swaziland preventing or limiting access to low cost prices through
local manufacturers or suppliers and therefore no barriers are foreseen in this regard
throughout the proposal period.
4.8.7 Multi-drug resistant tuberculosis
Yes
 include USD 50,000 per year over the full proposal term to
contribute to the costs of Green Light Committee Secretariat
Is the provision of treatment of multi-drug support services
resistant tuberculosis included in this
tuberculosis proposal?
No
 do not include the Green Light Committee costs
4B. CROSS-CUTTING HSS – PROGRAM DESCRIPTION
Read the Round 10 Guidelines to consider including

optional cross-cutting HSS interventions
SECTION 4B can only be included in the Round 10 tuberculosis proposal if:

 the applicant has identified gaps and constraints in the health system that have an impact on
tuberculosis, tuberculosis and malaria outcomes;
 the interventions required to respond to these gaps and constraints are 'cross-cutting' and
benefit more than one of the three diseases (and potentially benefit other health outcomes);
and
 section 4B is not included in the Round 10 HIV or malaria proposal.
Section 4B can be downloaded from the Global Fund's website if the applicant intends to apply for
cross-cutting HSS.
5. FUNDING REQUEST
The Round 10 Guidelines contain different guidance for sections 5.1 and 5.2 depending on whether the applicant selected Option 1, 2 or 3
in section 3.1 of the Proposal Form
5.1 Financial Gap Analysis

Section D and H of the Gap Analysis table below must be completed differently depending on whether applicant selected Option 1, 2 or 3
(see above)
 Summary Information provided should be described further in sections 5.1.1 – 5.1.3

 Currency must be the same as identified on the proposal cover page
 Adjust the years as necessary in the table from calendar years to financial years to align with national planning and fiscal periods
Financial gap analysis

Actual Planned Estimated
2008 2009 2010 2011 2012 2013 2014 2015
SECTION A: Funding needs for the full national tuberculosis program

LINE A  Provide annual amounts 9,213,735 13,240,108 22,201,573 24,004,578 23,399,175 23,314,157 25,466,810 26,103,480
LINE A.1  Indicate the amount of the funding need for the full national tuberculosis program
122,288,200
over the full term of the Round 10 proposal
2008 2009 2010 2011 2012 2013 2014 2015
SECTIONS B, C AND D: Current and planned resources to meet the funding needs of the full national tuberculosis program
Section B: Domestic
Domestic source B1:
Loans and debt relief
 provide name of source here
Domestic source B2
National funding resources 809,745 2,145,119 3,722,339 2,744,423 3,077,027 3,230,878 3,369,865 3,538,358
(Swaziland Government)
Domestic source B3
Private sector contributions 77,000 81,000 85, 000 89,000 94,000 96,350 -
(national)
LINE B: Total current & planned

DOMESTIC resources 809,745 2,222,119 3,803,339 2,829,423 3,166,027 3,324,878 3,466,215 3,538,358
 Total of Section B entries
Section C: External (non-Global Fund)

External source C1
 PEPFAR 1,139,907 1,497,050 2,391,154 2,913,125 2,465,407 2,467,777 1,438,266 536,404
External source C2
- 1,849,296 3,257,884 1,500,000 1,650,000 1,815,000 1,996,500 2,196,150
 MECINES SANS FRONTIERS (MSF)
External source C2
353,000 357,000 444,405 485,625 497,407
 WHO
External source C2
30,000 41,000 57,850 24,000
 KNCV
External source C3
Private sector contributions
(International)
LINE C: Total current & planned

EXTERNAL (non-Global Fund)
resources 1,522,907 3,744,346 6,151,293 4,922,751 4,612,813 4,282,777 3,434,766 2,732,554
 Total of Section C entries
2008 2009 2010 2011 2012 2013 2014 2015
Complete this version of Section D if the applicant selected Option 2 or 3 in section 3.1 of the Proposal Form:
Section D: External (Global Fund)
 Insert additional lines below if there are more than two existing tuberculosis Global Fund grants
Grant D1
 provide grant number here
Grant D2
LINE D: Total current & planned
EXTERNAL (Global Fund) resources
 Total of Section D entries
Complete this version of Section D if the applicant selected Option 1 in section 3.1 of the Proposal Form:
Section D: External (Global Fund)
 Insert additional lines below if there are more than two existing tuberculosis Global Fund grants
Section D1: Grants not included in
consolidated disease proposal
Grant D1-A
Grant D1-B
Section D2: Grants included in

consolidated disease proposal and
listed in section 3.1(b) 2,108,199 2,055,673 2,132,352 2,369,582 2,551,872 0
Grant D2-A
 TB-SWZ-809-G07-T
Grant D2-B
LINE D: Total current & planned
EXTERNAL (Global Fund) resources 2,108,199 2,055,673 2,132,352 2,369,582 2,551,872
 Total of Section D entries
2008 2009 2010 2011 2012 2013 2014 2015
LINE E : Total current and planned

resources 2,332,652 5,966,465 12,062,831 9,807,846 9,911,193 9,977,237 9,452,853 6,270,912
 Line E = Line B + Line C + Line D
Calculation of gap in financial resources and summary of total funding requested in Round 10  must be supported by detailed budget
LINE F: Total funding gap
Line F = Line A – Line E
6,881,083 7,273,643 10,138,742 14,196,732 13,487,982 13,336,920 16,013,957 19,832,568
LINE G: Round 10 tuberculosis funding request 10,489,404.8 10,547,100.9

 must be same amount as requested in tables 1.1, 5.3, 5.4 7,702,629.11 9,268,906.03 9,704,613.51
and detailed budget for this disease 8 5

Part H – Cost Sharing calculation for Lower-middle income and Upper-middle income applicants
In Round 10, the total maximum funding request for tuberculosis in Line G is:
(a) For Lower-Middle income countries, an amount that results in the Global Fund's overall contribution (all grants) to the national program being not more than 65% of
the national disease program funding needs over the proposal term; and
(b) For Upper-Middle income countries, an amount that results in the Global Fund overall contribution (all grants) to the national program being not more than 35% of
the national disease program funding needs over the proposal term.
Line H = Cost Sharing calculation as a percentage (%) of overall funding from Global Fund
Complete this cost sharing calculation if the applicant selected Option 2 or 3 in

section 3.1 of the Proposal Form:
Cost sharing = (Total of Line D amounts for proposal period + Total of Line G amounts) X
100
Line A.1 46%

Complete this cost sharing calculation if the applicant selected Option 1 in section
3.1 of the Proposal Form:
Cost sharing = {Total of Line D1 amounts for proposal period ($9,109,479.00) + Total of Line G
amounts ($47,712,654.48)} X 100
Line A.1 ($122,288,200)
5.1.1 Explanation of financial needs and additionality of Global Fund financing
Describe how the annual amounts were:
(a) developed;
(b) budgeted in a way that ensures that government, non-government and community needs were
included to reflect implementation of the country's tuberculosis program strategies; and
(c) developed in a way that demonstrates the funding requested in the proposal will contribute to
the achievement of outputs and outcomes that would not be supported by currently available
or planned domestic resources.

The total financial needs of the National Tuberculosis programme as reflected in the 2010 – 2014
Strategic Plan was determined through a thorough a broad-based participatory process of planning.
The national TB Programme held series of consultative meetings with all stakeholders where the
status of the programme was critically examined, priority areas of intervention identified on the
basis of which activities to be implemented within the plan period were agreed upon. The
identification of programme priority intervention areas was guided by the epidemiological situation
as well as the level of programme performance with respect to achieving the desired outcomes for
TB control in the country with particular reference to the Millenium Development Goals (MDGs) and
the Stop TB Partnership targets for 2015. The priority interventions took into consideration a
comprehensive approach to the implementation of the TB programme strategies at national,
regional and community levels. The agreed activities were then dully costed using the WHO TB
planning and budgeting tool. The strategic objectives and activities of the national strategy is
consistent with the Stop TB Strategy and also consistent with the National Health Sector Strategic
Plan (HSSP).
The National Strategic Plan has 6 objectives namely 1) To pursue enhancement and expansion of
high quality DOTS; 2) To address TB/HIV, MDR-TB and TB in high risk groups; 3) To contribute to
Health systems strengthening; 4) To engage all care providers in TB control; 5) To empower people
with TB and communities to participate in TB control; 6) To enable and promote programme-based
operational research.
For each of the 6 objectives of the strategic plan and their related activities, the annual
government funding and partner contributions (mainly PEPFAR, MSF and WHO); including existing
Global Fund support were mapped and reflected, which enabled the accurate determination of
funding gaps. The total financial implications for the National Strategic plan 2010 – 2014 amounts
to US$117m. However, to implement the national strategy within the round 10 grant proposal
period (2011 – 2015), a total sum of US$122,288,200.00 is required, which includes
US$26,188,103 extrapolated for the 2005 which is not covered in the National Strategic Plan.
In developing this proposal, a comprehensive programmatic and financial gap analysis was
conducted to identify priority interventions that are currently needed but not funded or under-
funded by current resources. This therefore ensured that resources requested in the current
consolidated Round 10 proposal does not duplicate but rather compliment existing resources to
scale up the TB control interventions in the country.
The total amount indicated annually represents the total financial requirement at both national
and regional levels to effectively implement the program on annual basis, which is reflected in line
A of table 5.1.
The costed national strategy will be used to budget for TB Control in the development of annual
government (MOH) budget proposals for cabinet approval every fiscal year. Same national strategy
will be referred to by partners supporting the national TB programme in planning their
development assistance.
5.1.2 Domestic funding

 corresponds to LINE B in Table 5.1
Describe the processes used in country to:
(a) prioritize domestic financial contributions to the national TB program including HIPC [Heavily
Indebted Poor Country] and other debt relief, and grant or loan funds that are contributed
through the national budget; and
(b) ensure that domestic resources are used efficiently, transparently and equitably, to help
implement treatment, prevention, care and support strategies at the national, sub-national and
community levels.
ONE PAGE MAXIMUM

The domestic sources of funding reflected in line B of table 5.1 represents the government
budgetary allocations to the National TB programme on an annual basis. The Swaziland Government
funding covers salaries of Program staff, supervision, program management including fueling and
maintenance of programme vehicles and motorcycles.
5.1.3 External funding

 corresponds to LINE C in Table 5.1
Describe:
(a) any changes in contributions anticipated over the proposal term and the reason for any
identified reductions in external resources over time; and
(b) any current delays in accessing the external funding identified in Table 5.1 that should be
explained, including the reason for the delay, and plans to resolve the issue(s).
ONE PAGE MAXIMUM

Although Swaziland has few external partners supporting the National TB Programme, the current
support can be described as fairly consistent and predictable. The supporting partners
reflected in the table 5.1 includes 1) PEPFAR funding through URC; 2) MSF funding for MDR-
TB and TB/HIV activities in two regions of the country; 3) WHO support and 4) KNCV.
PEPFAR funding which represents a considerable proportion of the external partner’s contribution
will last until 2014 which is the 4th year of this grant proposal. This has been considered in
the development of this proposal. URC has an established presence in Swaziland, and until
now, most of the PEPFAR funding through the organization have been timely except in
circumstances where an unplanned activity is requested in which case going through higher
level approval may result in some delays.
MSF has also signed an MoU with the ministry of Health which clearly spelt out the extent of
support expected in the coming three years i.e until 2013. This includes the 30-bed MDR-TB
ward and laboratory to be constructed in the Shiselweni Region. Furthermore, the
commitment made to provide second line anti-TB medications for one year before
commencement of this grant has been guaranteed by MSF and reflected in their
contribution of 2010. Again these support have been considered in the development of this
proposal.
WHO and KNC support are mainly technical assistance contributions. WHO has an international
position of a TB Medical Officer in the country office for which funding is currently
available until 2012. The TA plan in this grant proposal has considered provision of funding
for the position beyond 2012. Similarly, KNCV commitment to support monitoring missions
on a biannual basis will be sustained. However, funds have been proposed in the TA plan to
provide for specific TA missions that may be needed by the National TB Programme.
5.2 Detailed Budget
Instructions for completion of the detailed budget:

 For guidance on the level of detail required (or for a template) refer to the budget information available in
Section 5.2 of the Guidelines
1. Submit a detailed budget in Microsoft Excel format.

2. Ensure that this detailed budget is consistent in numbering with the Round 10 interventions in
section 4.4.1 of the Proposal Form, the Performance Framework, and the detailed work plan.
3. From the detailed budget, prepare table 5.3, the summary by objective and service delivery
area.
4. From the detailed budget, prepare table 5.4, the summary by cost category.
5. Do not include a request for CCM or Sub-CCM funding in this Round 10 proposal. Requests for
funding are available through a separate application. The application is available at:
http://www.theglobalfund.org/en/ccm/
5.3 Summary of Detailed Budget by Objective and Service Delivery Area
 Use the same objective and SDA numbering as the description in section 4.4.1, the Performance Framework, and the detailed budget and work plan.
 Annual totals at the end of this table must equal annual totals in the detailed budget and tables 1.1 and 5.4
Objective
Service delivery area Year 1 Year 2 Year 3 Year 4 Year 5 Total
number
ACSM (Advocacy, communication

4
and social mobilization) 445,500.00 348,011.15 405,526.32 325,793.22 325,793.22 1,850,623.91
CSS: Building community linkages,
4
collaboration and coordination 148,454.05 111,647.64 96,596.13 ‐ ‐ 356,697.82
CSS: Community based activities
4 and services ‐ delivery, use and
quality 70,864.86 112,236.49 91,477.70 98,398.13 31,850.33 404,827.51
CSS: Human resources: skills
4 building for service delivery,
advocacy and leadership 28,601.35 45,142.91 81,346.62 85,413.95 85,413.95 325,918.78

1
High quality DOTS 245,918.92 299,987.84 311,083.78 315,718.75 373,224.56 1,545,933.85

2
High risk groups 32,983.78 34,632.97 36,364.62 38,182.85 38,182.85 180,347.08
Human Resource Development
1
(HRD) 1,018,656.98 1,465,859.83 1,200,410.94 1,357,571.61 1,108,923.40 6,151,422.76

1
Improving diagnosis 591,651.84 576,034.26 414,605.26 387,779.66 380,617.09 2,350,688.10

2
Infection Control 234,445.95 272,326.01 243,922.54 173,850.25 182,542.76 1,107,087.50

1
M&E 289,262.16 302,646.89 252,970.11 425,120.57 253,416.63 1,523,416.37

3 MDR‐TB 22,860,220.2
3,276,491.92 3,942,225.99 4,709,734.95 5,214,878.93 5,716,888.43 2

Objective
Service delivery area Year 1 Year 2 Year 3 Year 4 Year 5 Total
number
3 MDR‐TB Patient support 134,391.89 185,381.76 232,383.16 188,661.59 235,826.98 976,645.38

Partnering initiatives at country
4
level 162,114.86 69,477.36 162,343.13 79,031.37 79,031.37 551,998.10

1
Patient Support 305,513.51 395,920.95 360,070.54 528,252.45 481,321.70 2,071,079.15
Programme management and
1
Administration cost 247,587.84 247,196.96 305,720.27 312,425.78 295,741.90 1,408,672.75
Technical and Management
1
Assistance 56,756.76 321,810.81 275,327.03 354,796.42 354,796.42 1,363,487.43

2
TB/HIV 413,432.43 538,366.22 524,730.41 603,529.36 603,529.36 2,683,587.77
47,712,654.4
Round 10 tuberculosis funding request:
7,702,629.11 9,268,906.03 9,704,613.51 10,489,404.88 10,547,100.95 8
5.4 Summary of Detailed Budget by Cost Category
 Summary information provided in the table below should be described further in sections 5.4.1 to 5.4.3
 Annual totals at the end of this table must equal annual totals in the detailed budget and tables 1.1 and 5.3
Cost Category Year 1 Year 2 Year 3 Year 4 Year 5 Total

Human resources
2,016,182.43 2,713,256.76 3,170,506.93 3,179,088.55 3,244,791.59 14,323,826.25

Technical and management assistance
56,756.76 321,810.81 275,327.03 354,796.42 354,796.42 1,363,487.43

Training
663,158.33 789,709.49 466,958.96 670,247.41 399,064.62 2,989,138.82

Health products and health equipment
491,878.86 518,522.64 494,146.16 456,110.82 457,640.76 2,418,299.24

Pharmaceutical products (medicines)
2,274,600.02 2,711,153.36 3,189,657.06 3,658,402.08 4,097,055.06 15,930,867.58

Procurement and supply management costs
‐ ‐ ‐ ‐ ‐ ‐

Infrastructure and other equipment
484,837.84 443,809.46 209,266.42 63,356.50 61,009.97 1,262,280.19

Communication materials
360,317.57 231,908.11 243,503.51 202,459.23 138,257.97 1,176,446.39

Monitoring & Evaluation
325,521.62 330,077.43 340,055.70 516,560.43 344,856.49 1,857,071.67

Living support to clients/target populations
610,851.35 862,532.43 912,059.51 980,508.38 1,041,752.99 4,407,704.67

Planning and administration
390,145.95 316,328.24 371,845.08 375,023.56 375,023.56 1,828,366.38

Overheads
28,378.38 29,797.30 31,287.16 32,851.52 32,851.52 155,165.88

Other (specify):
‐ ‐ ‐ ‐ ‐ ‐

Round 10 tuberculosis funding request:
7,702,629.11 9,268,906.03 9,704,613.51 10,489,404.88 10,547,100.95 47,712,654.48
5.4.1 Overall budget context

Describe any significant variations in cost categories by year, or significant five year totals
for those categories.
HALF PAGE MAXIMUM

The overall budget context reflect an initial high capital investment in infrastructure and
laboratory equipment in the first two years to urgently address the issue of access to
services especially for the rural population which also has some equity dimensions.
Expenditure in the subsequent years is mainly dedicated to maintenance of quality
services. The round 10 consolidated proposal funding request amounts to
US$47,712,654.48, which represents 39% of total financial requirement to implement the
national TB control strategy with the period 2011 – 2015. This includes carryover funds
from the existing round 8 grant in the consolidation process.
On average, the Round 10 proposal seeks about US$10m annually to effectively provide
quality DOTS, TB/HIV, MDR/XDR-TB prevention and management services including
activities to increase demand for services. This reflects a rapid scale up of the response to
particularly the huge burden of MDR-TB over the proposal period. There is no considerable
variation in the cost categories except for the steady annual increase in the cost of second
line anti-TB medicines based on the estimated increase in the annual patient enrolments.
The budgeting process took into consideration an inflation factor of about 5% to cater for
increases in prices of products in services in subsequent years. Procurement of second line
drugs and ensuring proper management and supervision of the programme constitute about
33.4% of the total funding requested.
Human resources (mainly salaries and remuneration field staff) also represent a
considerable proportion of the funding requested (30%). Two important service delivery
areas (improving diagnosis and infection control) require high initial capital investment to
procure equipment in the first year while maintenance of these equipment and other
support services will be sustained in the subsequent years, which is reflected in the
funding request under the respective cost categories. Similarly the initial high cost in the
management and supervision cost category is due to the need to procure in the first year 6
vehicles for strengthening supervision activities.
Overall about 3.9% of the funding request is allocated for strengthening M&E which is
mainly to incorporate and streamline MDR/XDR-TB surveillance into the national TB
surveillance system. The funding request is therefore meant to be complimentary to the
overall programme M&E budget requirement. The technical and management assistance
component of the proposal constitute 3% of the total funding request.
5.4.2 Human resources

(a) Describe how the proposed financing of salaries, compensation, volunteer stipends, or
top-ups will be consistent with agreed in-country salary frameworks, such as national
salary or inter-agency frameworks.
 Attach supporting information as evidence, including draft documents where applicable
HALF PAGE MAXIMUM

Human Resources represents a considerable proportion of the requested funds in this
proposal. This is against the background of the prevailing HR crises in Swaziland vis-à-vis
the urgency of the TB situation in the country. While the HR recruited under the round 8
proposal will be maintained in the consolidated proposal, round 10 funding is specifically
requested for the following positions:
 8 positions of Medical Officers for the 4 regional MDR/XDR-TB clinical teams to be
established;
 12 positions each for Nurses for the regional MDR/XDR-TB clinical teams;
 Incentives for Community Health Care workers that provide treatment adherence
support to MDR/XDR-TB patients; and
 20 Additional Adherence officers to scale up contact investigation and defaulter
tracing activities;
 3 additional staff to strengthen capacity of the Swaziland Stop TB Partnership to
implement ACSM component of the Round 10 grant and coordinated in-country TB
stakeholders;
The cost calculation for salaries is based on current Government salary scale, while the
incentives for community health care workers is also based on the current rate for all
Community-based Care Givers (CBCGs) used in the country.
(b) In cases where human resources represents an important share of the budget,
summarize: (i) the basis for the budget calculation over the initial two years; (ii) the
method of calculating the anticipated costs over years three to five; and (iii) to what
extent human resources spending will strengthen service delivery.
HALF PAGE MAXIMUM

The HR compliment of this proposal is deemed extremely necessary to only to optimize
and scale up the current MDR/XDR-TB management program but to ensure quality DOTS
expansion in general. This is in view of the human resource crises currently faced by the
health sector.
The basis of the budget calculation over the next two years are:
 The current Government salary rate for the same job level to which is factored the
housing, transport and gratuity;
By developing 4 regional clinical teams with strong MDR/XDR-TB management capabilities,
access to timely diagnosis and quality treatment will be increased to the population as
opposed to the current crises situation where the management is highly centralized at the
National TB Hospital, the facility and staff are overstretched and potentially compromising
the quality of care. At the regional level, the team is also needed to run outreach services
on a regular basis to strengthen the basic DOTS and support peripheral health facilities.
Another area of considerable HR investment is the laboratory services which require urgent
attention. With recruitment of additional laboratory technologists and microscopists,
quality-assured AFB microscopy services will be extended especially to the rural
population.
MDR-TB surveillance is one of the elements earmarked for strengthening. Therefore
engaging four (4) data clerks will ensure maintenance of accurate clinical and outcome
data on MDR-TB cohorts under the GLC project.
Overall, these HR investments will undoubtedly strengthen the services delivery and
improve TB control outcomes in the country.
5.4.3 Other large expenditure items

If ‘other’ cost categories represent important amounts in the summary in table 5.4, (i)
explain the basis for the budget calculation of those amounts; and (ii) explain how this
contribution is important to implementation of the national tuberculosis program.
HALF PAGE MAXIMUM
Beside Human Resources, the other large expenditure items in this proposal are mainly
related to second-line drugs and provision of living support to MDR/XDR-TB patients.
The calculation of the cost of treatment is based on the requirement per patient in terms
of second line drugs based on the approved regimen in the Swaziland national MDR-TB
management guidelines. Support for GLC operations at the rate of US$50,000 per annum,
which is essential for a successful MDR/XDR-TB program has been included in the budget.
The living support to patients was calculated based on the minimum required for provision
of food packages to all enrolled patients; and provision of enhanced nutritional package to
the often severely malnourished MDR-TB patients.
The living support to patients is a crucial part of the MDR/XDR-TB management as it
guarantees treatment adherence and therefore increasing the chances of cure and
reduction in transmission of drug resistant TB.

5.4.4 Measuring service unit cost and cost effectiveness
Provide the following:
(a) where available, estimates of recent average service delivery unit costs at the
program-level for key services with an explanation of how the estimates were
developed;
(b) estimates of the expected average service delivery unit costs for key services that are
included in the proposal; and
(c) a description of how key service delivery unit costs will be measured at the program-
level, over time throughout the lifecycle of the grant.
HALF PAGE MAXIMUM

Although very much desired and appreciated as a principle, a systematic measure of
average service delivery unit costs have so far not been conducted in any of the health
sector interventions in Swaziland. Information regarding service delivery unit costs for
services proposed in this proposal are therefore not available. However, part of the
information for example to the unit cost in terms of second line anti-TB drugs per person to
be treated in this proposal is $2,823.44 for one year of MDR-TB treatment. From the
service provider perspective, calculating the total cost of service delivery requires costing
unit of staff time, hospital bed space, feeding, adherence support and other health service
inputs.
The national TB programme will collaborate with other stakeholders including the PR and
partners supporting the programme to sensitize the Ministry of Health to establish
measurement or estimation of service delivery unit costs during the proposal period.
5.5 Funding Requests in the Context of a Common Funding Mechanism
 In this section, common funding mechanism refers to situations where all funding is contributed
into a common fund for distribution to implementing partners
5.5.1 Common funding mechanism

Yes
If the country’s response to tuberculosis is through a program-
based approach, does the proposal plan for some or all of the  complete all of section 5.5
requested funding to be paid into a common-funding
mechanism to support that approach?
No
 do not complete section 5.5
5.5.2 Operational status of common funding mechanism

Describe the main features of the common funding mechanism, including the fund's name,
objectives, governance structure and key partners.
HALF PAGE MAXIMUM

Not applicable
5.5.3 Measuring performance
Describe how program performance helps determine financial contributions to the common
fund.
HALF PAGE MAXIMUM

Not applicable
5.5.4 Additionality of Global Fund request

Describe how the funding requested in the proposal will contribute to the achievement of
outputs and outcomes that would not be supported by current or planned resources available
to the common funding mechanism.
HALF PAGE MAXIMUM

Not applicable
5B. CROSS CUTTING HSS – FUNDING REQUEST
Read the Round 10 Guidelines to consider including

optional cross-cutting HSS interventions
SECTION 5B can only be included in the Round 10 tuberculosis proposal if:

 the applicant submitted section 4B with tuberculosis.
Section 5B can be downloaded from the Global Fund's website if the applicant intends to
apply for cross-cutting HSS interventions.
PROPOSAL CHECKLIST: SECTIONS 3-5 Tuberculosis
CHECKLIST
Document List
attached? document
Section 3 and 4: Proposal Summary and Program Description
 mark an ‘X’ name and
if attached number
4.1 National Health Sector Development / Strategic Plan X T.B. 01
4.1 National Tuberculosis Control Strategy and/ or Costed X

T.B 02
Implementation Plan
Sub-sector policies that are relevant to the proposal (e.g.
4.1 X
national or sub-national human resources policy, norms
and standards, gender policies/strategies and plans, T.B 03
policies on community or CSO partnerships with
government health or other systems)
4.1 Most recent self-evaluation reports/technical advisory X
reviews, including any epidemiology report directly T.B 04
relevant to the proposal
4.1 National Monitoring and Evaluation Plan (e.g. health X

T.B 05
sector, disease-specific, or other)
4.1 National policies to achieve gender equality in regard to

the provision of tuberculosis prevention, treatment, and N/A
care and support services to all people in need
4.1 Most recent bio-behavioral surveillance of key

N/A
population(s)
4.1 National report on gender specific operational research

and any gender analysis/assessments that might have N/A
been undertaken of the tuberculosis response
4.1 National pharmacovigilance policy N/A
4.2 (b) Map if proposal targets specific region/population group N/A
4.3.2 Any recent report on health system weaknesses and gaps

that impact outcomes for the three diseases (and beyond N/A
if it exists)
4.4 Document(s) that explain basis for coverage targets X T.B 06
4.4.1 x Performance
A completed Performance Framework (mandatory)
Framework
4.4.1 A detailed work plan (mandatory) x work plan
4.4.2 A copy of the Technical Review Panel (TRP) Review Form

from Round 8 or 9, if relevant.
4.6.1 A recent evaluation of the Impact Measurement Systems

as relevant to the proposal (if one exists)
4.7.1 A recent assessment of the Principal Recipient capacities

(other than Global Fund Grant Performance Report)
4.7.1 Documents describing the organization, such as official

registration papers, summary of recent history of
organization, management team information
 only for Non-CCM applicants
4.7.2 List of Sub-recipients already identified (including name,

sector they represent, and SDA(s) most relevant to their
activities during the proposal term)
4.8.6 A completed tuberculosis Pharmaceutical and Health X

Products List  only mandatory if applicant is procuring these
products
Document List
attached? document
Section 4B: Cross-cutting HSS (only one per country’s application)
if attached number
4B.2 A completed separate cross-cutting HSS Performance Performance

Framework (mandatory, if applicable) Framework
4B.2 A detailed separate cross-cutting HSS work plan

work plan
(mandatory, if applicable)
Document List
attached? document
Section 5: Funding Request
if attached number
5.2 X detailed
A detailed budget (mandatory)
budget
5.4.2 Information on basis for budget calculation and diagram

and/or list of planned human resources funded by
proposal
5.4.3 Information on basis of costing for ‘other’ cost category

items
5.5.1 Documentation describing the functioning of the common

funding mechanism
 only include if there is a common funding mechanism
5.5.2 Most recent assessment of the performance of the

common funding mechanism
 only include if there is a common funding mechanism
Document List
attached? document
Section 5B: Cross-cutting HSS Funding Request
if attached number
5B.1 A separate cross-cutting HSS detailed budget detailed

(mandatory, if applicable) budget
5B.4.2 Information on basis for budget calculation and diagram

and/or list of planned human resources funded by
proposal (only if relevant)
5B.4.3 Information on basis of costing for ‘other’ cost category

items
Document List
Other documents relevant to sections 3, 4 and 5 attached? document
attached by applicant  mark an ‘X’ name and
if attached number
4.6.1 Ministry of health annual action plan X T.B.07
4.6.2 National Health Policy X T.B 08
4.6.3 TB Guidelines X T.B.09
4.6.4 MDR TB Guidelines T.B 10
4.6.5 TB emergency response plan X T.B 11
4.6.6 M&E system strengthening report X T.B.12
4.2 Report of National Survey on the prevalence of anti- X

T.B.13
tuberculosis drug resistance in the Kingdom of Swaziland.
4.2 MOH National Policy Guidelines for TB/HIV collaborative x

T.B. 14
activities
SWAZILAND ‐ PROPOSAL FORM – ROUND 10
SINGLE AND MULTI‐COUNTRY APPLICANT
Consolidated Performance Framework: Indicators, Targets and Periods Covered
Program Details
Country: SWAZILAND
TB
Disease: TUBERCULOSIS
A. Periods covered and dates for disbursement requests and progress updates (typically completed by the Secretariat during Grant negotiations process)
Period Period
Round 8 Period _6/7_ Period _8/9_ Period _10/11_ Period _12/13_ Period _14/15_
_16/17_ _18/19_
P _20/_
Round 10 P __1 P __2 P __3 P __4 P __5 P __6 P __7 P __8 P __9 P __10
Consolidated Round 10 P1 P2 P3 P4 P5 P6 P7 P8 P9 P10
Period Covered: from 1-Apr-11 1-Oct-11 1-Apr-12 1-Oct-12 1-Apr-13 1-Oct-13 1-Apr-14 1-Oct-14 1-Apr-15 1-Apr-16
Period Covered: to 30-Sep-11 31-Mar-12 30-Sep-12 31-Mar-13 30-Sep-13 31-Mar-14 30-Sep-14 31-Mar-15 31-Mar-16
B. Program Goal, impact and outcome indicators
Consolidated goals:
1 To contribute towards achievement of the MDG targets for TB control in Swaziland by 2015. To reduce morbidity, mortality, disease transmission and socio-economic impact of TB including TB/HIV co-infection and MDR-TB
2
Baselines Targets over consolidation period

Impact
indicator Round Impact indicator formulation Report Report due Report due Report due Report due Comments
number value Year Source Year 1 Year 2 Year 3 Year 4 Year 5
due date date date date date
TB prevalence rate
Round 8 812 2007 WHO Global Reports 600 Apr-12 550 A 450 Apr-14 406 Apr-15 Apr-16
1 TB prevalence rate The decline in TB prevalance projected in the Round 8

PF is now considered unrealistic by NTP and partners
given the upward trend in TB case notification of
R10 (consolidated) 812 2008 WHO Global Reports 832 April 12 853 April 13 874 April 14 892 April 15 1,070 April 16
about 10% annually in the last 5 years.
TB incidence rate
Round 8 1,198 2008 WHO Global Reports 950 Apr-12 900 Apr-13 800 Apr-14 600 Apr-15 Apr-16
2 TB incidence rate The decline in TB prevalance projected in the Round 8

PF is now considered unrealistic by NTP and partners
R10 (consolidated) 1,198 2008 WHO Global Reports 1,228 April 12 1,259 April 13 1,290 April 14 1,316 April 15 1,579 April 16 given the upward trend in TB case notification of
about 10% annually in the last 5 years.
TB mortality rate
Round 8 317 2007 WHO Global Reports 250 Apr-12 200 Apr-13 170 Apr-14 150 Apr-15 Apr-16
3 TB mortality rate
R10 (consolidated) 317 2007 WHO Global Reports 275 April 12 250 April 13 215 April 14 195 April 15 160 April 16
Baselines Targets over consolidation period

Outcome
indicator Round Outcome indicator formulation Report Report due Report due Report due Report due Comments
number value Year Source Year 1 Year 2 Year 3 Year 4 Year 5
due date date date date date
Case detection rate: new smear positive TB cases This indicator has been dropped as TB ioutcome
R&R TB system, indicator and instead the Case notification rate is
Round 8 55 2008 yearly management 70 70 70 70 currently recommended by WHO Stop.
report
Apr-12 Apr-13 Apr-14 Apr-15 Apr-16
Case Notification Rate for smear positive TB cases This is a new TB impact outcome recommended
R&R TB system,
by the WHO Stop TB Department for round 10
Round 10 1,083 2009 yearly management 1,090 1,100 1,120 1,150 1,200
report application.
1 Case Notification Rate for smear positive TB cases The consolidated indicator is based on the newly
R&R TB system,
recommended TB outcome indicator.
R10 (consolidated) 1,083 2009 yearly management 1,090 1,100 1,120 1,150 1,200
report
Treatment success rate: new smear positive TB cases

R&R TB system,
Round 8 55 2007 yearly management 85 Apr-12 85 Apr-13 85 Apr-14 85 Apr-15 Apr-16
report
2 Treatment success rate: new smear positive TB cases These targets as stated in the round 8 PF were based
on the National Strategic Plan 2006-2009 targets
R&R TB system, which given the current situation has been
R10 (consolidated) 68 2008 yearly management 75 78 80 82 85 overambitious. New targets have been set for the
report consolidated proposal using the 2008 treatment
success rate of 58% as baseline.
C. Program Objectives, Service Delivery Areas and Indicators
Objective
Consolidated objectives:
Number
1 Pursue high quality DOTS enhancement and expansion

2 Address TB/HIV and other challenges
3 Prevention and Management of drug resistant TB
4 Empower people with TB, and communities
R10_CCM_SWZ_T_ConsPerfFW_27Sep10_En.xls Consolidated Perf. Framework 1/2

Country: SWAZILAND
TB
Disease: TUBERCULOSIS
Baseline
Targets for existing grants and for the consolidated grant
Target Cumulation²
Indicator
Objective Number Round Service Delivery Area Indicator formulation Baselines Tied to Y-over program term
Number
Value Year Source included in the Y-cumulative annually 6 months 12 months 18 months 24 months 30 months 36 months Year 4 Year 5
DTF: Name of PR
targets N-not cumulative
responsible for
Comments/Explanations³ implementation of
the corresponding
1 Period Period Period Period Period Period
Reporting periods (Round X) Period _6/7_ Period _8/9_ _10/11_ _12/13_ _14/15_ _16/17_ _18/19_ 20/21__
activity
1
Reporting periods (Round Y) Period __ Period __ Period __ Period __ Period __ Period __ Period __ Period __
Round 10 reporting periods Period 1 Period 2 Period 3 Period 4 Period 5 Period 6 Period 7/8 Period 9/10
Improving diagnosis # (%) of laboratories performing regular EQA for smear NTCP/NRL
microscopy. R&R TB system,
Round 8 9 (47%) 2010 quarterly reports
Yes National Program 15 (79%) 18 (95%)
1 1.1 Improving diagnosis # (%) of laboratories performing regular EQA for smear Y - over program term
microscopy. R&R TB system,
R10 (consolidated) 9 (47%) 2010 quarterly reports
Yes National Program 15/19 (79%) 18/19 (95%) 18/19 (95%) 21/ (95%) 24/25 (95%) 24/25 (95%) 27/28 (95%) 30/30 (100%)
High Quality DOTS # health facilities enroling and initiating TB patients on TB New indicator NTCP
Round 10 treatments 17 2008 TB patient register No National Program 30 40 50 60 67 70 70 70
2 1.2 High Quality DOTS # health facilities enroling and initiating TB patients on TB
R10 (consolidated) treatments 17 2008 TB patient register No National Program 30 40 50 60 67 70 70 70
Patient support # (%) of new TB patients who are supported (including daily NTCP/GSH
D.O.T.) by the community throughout treatment among estimated 3,826/9565 R&R TB system, 3,162/5,272 6,324/10,544
Round 8 2008 quarterly reports
No GF
new TB patients (40%) (60%) (60%)
Y - over program term
3 1.3 Patient support # (%) of new TB patients who are supported (including daily
D.O.T.) by the community throughout treatment among estimated 3,826/9565 R&R TB system, 3,162/5,272 6,324/10,544 6,853/10,544 6,853/10,544 7176/11,044 7176/11,044 7731/11044 7731/11044
R10 (consolidated) 2008 quarterly reports
No GF NTCP/GSH
new TB patients (40%) (60%) (60%) (65%) (65%) (65%) (65%) (70%) (70%)
M&E # (%) of supervisory visits performed by the central NTCP to the NTCP
diagnostic sites / out of planned visits (quarterly) R&R TB system,
Round 8 0/80 (0%) 2007 quarterly reports
No National Program 30/40 (75%) 30/40 (75%)
Program management Y - cumulative annually

4 1.5 # (%) of supervisory visits performed by the central NTCP to the
and Supervision diagnostic sites / out of planned visits (quarterly) R&R TB system, 35/40 35/40
R10 (consolidated) 0/80 (0%) 2007 quarterly reports
No GF 30/40 (75%) 30/40 (75%) 40/40 (100%) 40/40 (100%) 40/40 (100%) 40/40 (100%)
(87.5%) (87.5%)
HSS: Health Workforce # of Health care staff trained in TB 222/242 242/242 The SDA changed from Health Workforce to Human Resource NTCP
Round 8 108/242 (45%) 2010 Training records Please select... National Program
Development
(92%) (100%)
N - not cumulative
5 1.6.1 Human Resource # of Health care staff trained in TB management Human Resource Development adopted as the SDA for Round
233/242 242/242 154/160 154/160 105/110 105/110 246/250 202/205
R10 (consolidated) Development (HRD) 108/242 (45%) 2010 Training records No National Program 10 consolidated
(96%) (100%) (96%) (96%) (95%) (95%) (98%) (98%)
Procurement and supply # (%) of TB diagnostic and treatment centers that reported no NTCP/CMS
management (First line stock-outs of first line drugs that resulted in the interruption of
R&R TB system, 146/162
Round 8 drugs) treatment during the year out of all treatment centers 81/162 (50%) 2008 quarterly reports
No National Program
(90%)
N - not cumulative
6 1.6.2 Procurement and supply # (%) of TB diagnostic and treatment centers that reported no The change of the indicator is motivated by the programme's
management (First line stock-outs of first line drugs that resulted in the interruption of intention to keep tracking performance of the drug supply
R&R TB system, 146/162 162/162 162/162 162/162 162/162 162/162 162/162 162/162
R10 (consolidated) drugs) treatment during the year out of all TB treatment centers 81/162 (50%) 2008 Please select... National Program management system which is considered very important. NTCP/CMS
quarterly reports (90%) (100%) (100%) (100%) (100%) (100%) (100%) (100%)
TB/HIV # of HIV+ TB patients initiated on ART NTCP/URC

Round 10 1,014 2009 TB patient register No National Program 1,500 1,800 2,100 2,400 2,700 3,000 3,300 3,500
7 2.1.1 TB/HIV # of HIV+ TB patients initiated on ART New indicator
R10 (consolidated) 1,014 2009 TB patient register No National Program 1,500 1,800 2,100 2,400 2,700 3,000 3,300 3,500
High-risk groups # (%) of new TB patients screened for HIV. 5804/9673 2873/3595
Round 8 2008 TB patient register No National Program
(60%) (80%)
N - not cumulative
8 2.1.2 High-risk groups # (%) of new TB patients screened for HIV. 5804/9673 2873/3595 2873/3595 3056/3595 3056/3595 3559/3955 3559/3955 4132/4350 4132/4350
R10 (consolidated) 2008 TB patient register No National Program
(60%) (80%) (80%) (85%) (85%) (90%) (90%) (95%) (95%)
MDR-TB # (%) of laboratory confirmed MDR-TB patients among smear NTCP/NRL
positive TB patients (new and retreatment) as a proportion of TB laboratory 259/370 259/370
Round 8 estimated number of MDR-TB patients among smear positive new 90/220 (45%) 2008 register
No National Program
(70%) (70%)
and retreatment patients
MDR-TB Number (%) Laboratory-confirmed MDR-TB patients enrolled on NTCP/NRL
second-line anti-TB treatment as percentage of estimated cases TB laboratory N - not cumulative 259/370 389/487 437/547 437/547 491/614 491/614 1104/1379 1240/1550
Round 10 90/220 (45%) 2008 No National Program
for the period. register (70%) (80%) (80%) (80%) (80%) (80%) (80%) (80%)
9 3.1 MDR-TB Number (%) Laboratory-confirmed MDR-TB patients enrolled on Indicator re-defined in line with new WHO recommendations
second-line anti-TB treatment as percentage of estimated cases. TB laboratory 259/370 398/498 437/547 437/547 491/614 491/614 1104/1379 1240/1550
R10 (consolidated) 90/220 (45%) 2008 register
No National Program NTCP/NRL
(70%) (80%) (80%) (80%) (80%) (80%) (80%) (80%)
MDR-TB % of laboratory confirmed MDR-TB patients enrolled in second- NTCP/MSF

Round 8 line anti-TB treatment 217 2010 TB patient register No GF 125 200
MDR-TB Percentage of MDR-TB cases initiated on a second-line anti-TB Interim outcome results at 6 months added to the indicator NTCP/MSF
Round 10 treatment who have a negative culture at the end of 6 months of 217 2010 TB patient register No GF 78 (30%) 159 (40% 197 (45%) 246 (50%) 270 (55%) 295 (60%) 662 (60%) definition
treatment. Y - over program term
10 3.2 MDR-TB Percentage of MDR-TB cases initiated on a second-line anti-TB Targets revised due to delay in the commencement of
R10 (consolidated) treatment who have a negative culture at the end of 6 months of 217 2010 TB patient register No GF 78 (30%) 159 (40% 197 (45%) 246 (50%) 270 (55%) 295 (60%) 662 (60%) enrollment to the GLC Cohort. NTCP/MSF
treatment.
MDR-TB # MDR-TB patients supported on treatment by MDR-TB treatment NTCP/GSH
Round 10 supporters through out treatment 0 2009 TB treatment card No Current grant 389 778 1,311 1,652 2,148 2,634 3,738 4,978
11 3.4 MDR-TB # MDR-TB patients supported on treatment by MDR-TB treatment

R10 (consolidated) supporters through out treatment 0 2009 TB treatment card No Current grant 389 778 1,311 1,652 2,148 2,634 3,738 4,978
CSS: Advocacy, % of the population with correct knowledge about TB (in terms of NTCP/Stop TB
communication and mode of transmission, symptoms, treatment and curability). Partnership
Round 8 to be established 2010 Surveys, No National Program 50% 50%
social mobilization
N - not cumulative
12 4.1.1 ACSM (Advocacy, % of the population with correct knowledge about TB (in terms of
communication and mode of transmission, symptoms, treatment and curability).
R10 (consolidated) to be established 2010 Surveys, No National Program 50% 50% 50% 50% 70% 70% 70% 70%
social mobilization)
ACSM (Advocacy, # % targeted targeted communities (Chiefdoms) reached with TB NTCP/Stop TB

communication and Social mobilization campaigns. Programme Partnership
Round 10 1 2009 Reports,
No National Program 4 8 12 16 20 24 32 40
social mobilization)
13 4.1.2 ACSM (Advocacy, # % targeted targeted communities (Chiefdoms) reached with TB

communication and Social mobilization campaigns. Programme NTCP/Stop TB
R10 (consolidated) 1 2009 Reports,
No National Program 4 8 12 16 20 24 32 40
social mobilization) Partnership
1 Reporting periods will have to be numbered according to the start date and duration of the consolidated grant. Additional columns may be added as necessary.
2 Please make note that all targets for the same indicator should be inserted in the same cumulation format.
3 Please explain and justify here any relevant changes from the existing rounds: drop of SDAs, changes in indicator selection or formulation (in particular if this refers to impact or outcome indicators or key SDAs), or changes
in targets from previously existing indicators.
R10_CCM_SWZ_T_ConsPerfFW_27Sep10_En.xls Consolidated Perf. Framework 2/2

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ROUND 10

PROPOSAL FORM – ROUND 10

Applicant Name SWAZILAND CCM

Income Level LOWER MIDDLE INCOME

Applicant Type CCM Sub-CCM Non-CCM

If your country is also part of a Round 10

Currency USD Euro

Does the proposal Is this being

Expand access to high quality

SECTION 1: FUNDING SUMMARY AND CONTACT DETAILS

Clarified section 1.1

1.1 Funding summary

Round 10 Funding Request

Tuberculosi $10,489,404.8 $10,547,100.9

1.2 Contact details

Primary contact Secondary contact

Name Mr. Mbuso C. Dlamini Mr. Vulindlela Msibi

Title CCM Chairperson CCM Executive Secretary

Organisation CCM CCM

E-mail addresses dlaminimb@gov.sz vdmsibi@swazi.net

1.3 List of Abbreviations and Acronyms used by the Applicant

2.1 Members and operations

Sector Representation Number of members

Non-government organisations (NGOs)/community-based

People living with the diseases 1

People representing key populations 0

Multilateral and bilateral development partners in country 2

Total Number of Members: 16

(c) Is there continuing active membership of people living

(d) Is there continuing active membership of males and

2.1.3 Member knowledge and experience in cross-cutting issues

2.2.1 Application history

Clarified section 2.2.2

2.2.3 Process to oversee program implementation

Clarified section 2.2.4:

Clarified section 2.2.5

2.2.6 Managing conflicts of interest

 Tick this box to

PROPOSAL CHECKLIST: SECTIONS 1 AND 2

List annex name and

CCM and Sub-CCM applicants only

Process used to invite submissions for possible

Process used to review submissions for possible

Process used to ensure the input of a broad range of

Process to oversee grant implementation by the CCM

Processes used to ensure the input of a broad range

2.2.6 Conflict of Interest policy HIV – TB 16

Minutes of the meeting at which the proposal was

Endorsement of the proposal by all CCM (or Sub-CCM)

Other documents relevant to sections 1 and 2 attached by applicant:

CANGO Minutes of CANGO Minutes-CCM Representation-Rev Senzo

Technical Working TWGs Workshop Proceedings @ Esibayeni Lodge

PROPOSAL FORM – ROUND 10

SECTIONS 3-5: Tuberculosis

Option 1: Transition to a single stream of funding by submitting

Relevant sections are marked in RED throughout the

Option 3: No transition to a single stream of funding in Round 10

(b) For options 1 or 2, list the

3.2 Duration of Proposal Planned Start Date To

Month and year: April 2011 March 2016

3.3 Alignment to in-country cycles

Objective 1: Pursue high quality DOTS enhancement and expansion